Background During the COVID-19 pandemia, non-invasive mechanical ventilation (NIV) has been largely applied. Few data are available about predictors of NIV failure in critical COVID-19 patients admitted to ICU. The aim of this study is to analyze clinical and laboratory features able to predict non-invasive ventilation success in avoiding endotracheal intubation. Methods A retrospective observational study was performed in our COVID-19 ICU during a 6-month period. Demographic, clinical, laboratory, imaging, and outcome data were extracted from electronic and paper medical records and anonymously collected. Results Eighty-two severe COVID-19 patients were supported by NIV at ICU admission. The median PaO2/FiO2 ratio was 125 [98.5–177.7]. NIV failed in 44 cases (53%). Patients who experienced NIV failure had a higher Charlson Comorbidity Index (median value 4) compared to those who were dismissed without endotracheal intubation (median 2, p < 0.0001). At Cox regression analysis, the Charlson Comorbidity Index represented a predictive factor related to NIV failure. PaO2/FiO2, CPK, INR, and AT III at ICU admission showed a significant relationship with the outcome, when single variables were adjusted for the Charlson Comorbidity Index. Conclusion The Charlson Comorbidity Index may be helpful to stratify patients’ risk of NIV failure in a severe COVID-19 population; even if this study, retrospective design does not allow definitive conclusions.

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