Management of patients with severe acute respiratory failure due to SARSCoV-2 pneumonia with non-invasive ventilatory support outside Intensive Care Unit

Link to article at PubMed

Minerva Med. 2021 Jan 19. doi: 10.23736/S0026-4806.21.07134-2. Online ahead of print.


BACKGROUND: COVID-19 has high mortality rate mainly stemming from acute respiratory distress leading to respiratory failure (ARF ). Aim of the study is evaluating the management of severe ARF due to COVID-19 pneumonia using non-invasive ventilatory support (NIVS), studing safety and effectiveness of non-invasive ventilatory support (NIVS).

METHODS: This is a retrospective, multicenter study. Primary outcomes were NIVS failure with intubation rate and hospital mortality . Secondary outcomes were: hospital stay and factors related to NIVS failure and mortality. These outcomes were compared with patients intubated and admitted to ICU.

RESULTS: 162 patients were hospitalized because of severe respiratory failure ( PaO2/FiO2 ratio < 250 ). 138 patients were admitted to Respiratory Intermediate Care Unit (RICU) for a NIVS trial. One hundred patients were treated successfully with NIVS (74.5%); 38 failed NIVS trial (27.5%). In-hospital mortality was 23.18% in RICU group and 30.55% in ICU group. Patients with NIVS failure were older, had a lower number of lymphocytes, a higher IL-6 , lower PaO2, PaCO2, PaO2/FiO2 ratio, higher respiratory rate (RR) and heart rate at admission and lower PaO2 and PaO2/FiO2 ratio and higher RR after 1-6 hours . Multivariate analysis identified higher age, C-reactive protein as well as RR after 1-6 hours and PaO2/FiO2 ratio after 1-6 hours as an independent predictor mortality.

CONCLUSIONS: NIVS is a safe and effective strategy in the treatment of severe ARF due to COVID 19 related pneumonia, that reduces mortality and length of hospital stay in the carefully selected patient.

PMID:33464224 | DOI:10.23736/S0026-4806.21.07134-2

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