Effectiveness and safety of noninvasive positive pressure ventilation in the treatment of COVID-19-associated acute hypoxemic respiratory failure: a single center, non-ICU setting experience

Abstract

The role of noninvasive positive pressure ventilation (NIPPV) in COVID-19 patients with acute hypoxemic respiratory failure (AHRF) is uncertain, as no direct evidence exists to support NIPPV use in such patients. We retrospectively assessed the effectiveness and safety of NIPPV in a cohort of COVID-19 patients consecutively admitted to the COVID-19 general wards of a medium-size Italian hospital, from March 6 to May 7, 2020. Healthcare workers (HCWs) caring for COVID-19 patients were monitored, undergoing nasopharyngeal swab for SARS-CoV-2 in case of onset of COVID-19 symptoms, and periodic SARS-CoV-2 screening serology. Overall, 50 patients (mean age 74.6 years) received NIPPV, of which 22 (44%) were successfully weaned, avoiding endotracheal intubation (ETI) and AHRF-related death. Due to limited life expectancy, 25 (50%) of 50 NIPPV-treated patients received a "do not intubate" (DNI) order. Among these, only 6 (24%) were weaned from NIPPV. Of the remaining 25 NIPPV-treated patients without treatment limitations, 16 (64%) were successfully weaned, 9 (36%) underwent delayed ETI and, of these, 3 (33.3%) died. NIPPV success was predicted by the use of corticosteroids (OR 15.4, CI 1.79-132.57, p 0.013) and the increase in the PaO 2 /FiO 2 ratio measured 24-48 h after NIPPV initiation (OR 1.02, CI 1-1.03, p 0.015), while it was inversely correlated with the presence of a DNI order (OR 0.03, CI 0.001-0.57, p 0.020). During the study period, 2 of 124 (1.6%) HCWs caring for COVID-19 patients were diagnosed with SARS-CoV-2 infection. Apart from patients with limited life expectancy, NIPPV was effective in a substantially high percentage of patients with COVID-19-associated AHRF. The risk of SARS-CoV-2 infection among HCWs was low.

Clinical Management of Adult Patients with COVID-19 Outside Intensive Care Units: Guidelines from the Italian Society of Anti-Infective Therapy (SITA) and the Italian Society of Pulmonology (SIP)

“…Mortality in patients treated with CPAP ranged from 14-24% [252,256,264,265,268,271] to 43-55% [254,260], although possibly reaching 84% when CPAP was the ceiling treatment [276]. Mortality in patients treated with NIV was reported in five studies and ranged from 5% to 52% (but reaching 86% in DNI patients) [261,263,269,272,274]. Pooling outcomes for the CPAP and NIV groups, Avdeev and colleagues estimated a mortality of 23% [255], and Bellani and colleagues estimated a mortality of 25% [270], while pooled results from Burns et al reported a 50% mortality among DNI patients [257].…”

Non-invasive respiratory support paths in hospitalized patients with COVID-19: proposal of an algorithm

“…Recent experience in COVID-19 related Acute respiratory failure (21 publications including 1553 patients) 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 with HFNC, CPAP and Bi-Level Ventilation (using negative pressure rooms in only one series 15 ) shows average success of 60%, 55% and 59%, respectively, and an average infection rate in health professionals of 5.2%, less than the 12% reported in New York City among the staff not necessarily working with NIRT. 28 …”

Outcomes of COVID-19 patients treated with noninvasive respiratory support outside-ICU setting: a Portuguese reality

“…Time to IMV was similar in survivors and deceased patients. Moreover, casualties in RICU were not reported and in-hospital mortality was lower than previously described 5 , 6 , supporting strategy safeness.…”