Effectiveness of noninvasive ventilation in COVID‐19 related‐acute respiratory distress syndrome

Abstract

Introduction: During this long COVID-19 pandemic outbreak, continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are being widely used to treat patients with moderate to severe acute respiratory failure (ARF). As for now, data on the efficacy of NIV in COVID-19 acute respiratory distress syndrome (ARDS) are lacking, and for this reason it is extremely important to accurately determine the outcomes of this strategy. This study aimed to evaluate clinical data and outcomes of NIV in patients with COVID-19 ARDS. Matherials and methods: Seventy-nine consecutive patients with sudden worsening of respiratory failure were evaluated. All patients (71% male) had a confirmed SARS-CoV-2 infection and signs, symptoms and radiological findings compatible with COVID-19 pneumonia and all of them underwent a trial of NIV. Primary outcomes were NIV success and failure defined by intubation and mortality rate.Secondary outcome was the duration of NIV. Results: NIV was successful in 38 (48.1%) patients (Table 1). EOT was necessary in 21 patients (26.6%). Death occurred in 20 patients (25.3%). In the group of patients having failed a trial with NIV and then being intubated, compared to those who continued NIV, there was no higher mortality rate. By evaluating the ICU survival outcome of the subgroup of patients intubated after NIV, 57% of the patients were discharged and 43% died. Conclusion: Previous studies conducted on patients undergoing invasive mechanical ventilation showed higher mortality rate than the present study. Our data showed that NIV can avoid intubation in almost half of the patients. Therefore, this data could reassure clinicians who would consider using NIV in COVID-19 ARDS-related treatment.

The Role of Noninvasive Respiratory Management in Patients with Severe COVID-19 Pneumonia

“…Recently, Ward-COVID, a multicentre study from 31 hospitals in Italy successfully applied CPAP/NIV in 909 patients (10.4% of all patients with respiratory failure) in a ward with an NIV failure rate 37.6% [ 47 ]. There are plenty of other studies from different countries describing successful application of CPAP [ 42 , 46 , 48 , 49 , 50 ] or NIV [ 41 , 51 , 52 ] in a ward, with the vast majority of patients receiving CPAP support. However, the experience of staff in the use of these modalities, the nurse/patient ratio and the intensity of the monitoring probably are not similar in all studies.…”

2020 Year in Review: Mechanical Ventilation During the First Year of the COVID-19 Pandemic

“…24 Specific NIV studies in COVID-19 largely focused on the use of CPAP in the non-ICU setting (Table 3). [183][184][185][186][187][188][189][190][191][192][193][194][195][196] Unfortunately 46% of these were research letters often lacking pertinent data. [183][184][185][186][187][188] Nonetheless, 71% of all studies reported relatively low failure rates of 11-28%; and relatively low associated mortality among those without care limitations (< 30%).…”

“…185,188,196 In 8 traditional observational studies, failure rates were 17-57% with associated mortality of 22-97%. [189][190][191][192][193][194][195][196] In some studies substantially higher mortality was reported in subjects in which the pre-NIV P aO2 /F IO2 was < 150 mmHg (53%), 189 or had care limitations in place (55-72%). 187,190,195 NIV duration was reported in 50% of studies with median values of 5-6 days.…”

“…183,190 In some studies median duration was 3-8 days when therapy was successful compared to 0.7-8 days in those requiring intubation, and 1.8 days in those with care limitations in place. 185 Risk factors associated with NIV failure included increased age, 186,189,190,195,196 admission Sequential Organ Failure Assessment (SOFA) score, 185,193,196 Severe Acute Physiology Score (SAPS-III), 196 vasopressor use, 196 renal replacement therapy, 196 and number of comorbidities. 190,193 Likewise, increased levels of C-reactive protein, 187,189,195 Interleukin-6, 187 lactate dehydrogenase, 190 d-dimers, 186 and decreased platelet levels, 189 also were associated with NIV failure.…”

Continuous Positive Airway Pressure (CPAP) for Moderate to Severe Covid19 Acute Respiratory Distress Syndrome (CARDS) in a Resource limited setting

“…Within this context, CPAP is a much less resource intensive option than IMV and was trialled for CARDS patients in Italy early in the pandemic with promising results(8). Studies conducted in various settings since then have produced mixed results on the effectiveness of CPAP in CARDS compared with IMV(9–15), but CPAP still retains its place in prominent guidelines(16,17). However, studies from resource limited settings, which now account for the majority of new Covid19 cases(18) and deaths have been limited.…”