Non-invasive ventilation versus mechanical ventilation in hypoxemic patients with COVID-19

Abstract

Purpose Limited mechanical ventilators (MV) during the Coronavirus disease (COVID-19) pandemic have led to the use of non-invasive ventilation (NIV) in hypoxemic patients, which has not been studied well. We aimed to assess the association of NIV versus MV with mortality and morbidity during respiratory intervention among hypoxemic patients admitted with COVID-19. Methods We performed a retrospective multi-center cohort study across 5 hospitals during March-April 2020. Outcomes included mortality, severe COVID-19-related symptoms, time to discharge, and final oxygen saturation (SpO2) at the conclusion of the respiratory intervention. Multivariable regression of outcomes was conducted in all hypoxemic participants, 4 subgroups, and propensity-matched analysis. Results Of 2381 participants with laboratory-confirmed SARS-CoV-2, 688 were included in the study who were hypoxemic upon initiation of respiratory intervention. During the study period, 299 participants died (43%), 163 were admitted to the ICU (24%), and 121 experienced severe COVID-19-related symptoms (18%). Participants on MV had increased mortality than those on NIV (128/154 [83%] versus 171/534 [32%], OR = 30, 95% CI 16-60) with a mean survival of 6 versus 15 days, respectively. The MV group experienced more severe COVID-19-related symptoms [55/154 (36%) versus 66/534 (12%), OR = 4.3, 95% CI 2.7-6.8], longer time to discharge (mean 17 versus 7.1 days), and lower final SpO2 (92 versus 94%). Across all subgroups and propensity-matched analysis, MV was associated with a greater OR of death than NIV. Conclusions NIV was associated with lower respiratory intervention mortality and morbidity than MV. However, findings may be liable to unmeasured confounding and further study from randomized controlled trials is needed to definitively determine the role of NIV in hypoxemic patients with COVID-19. Keywords COVID-19 • SARS-CoV-2 • Non-invasive ventilation • Mechanical ventilation • Critical care outcomes Abbreviations ICU Intensive care unit MV Mechanical ventilation NIV Non-invasive ventilation SD Standard deviation COVID-19 Coronavirus disease OR Odds ratio RCT Randomized controlled trial * Ron Do

Impact of asthma on COVID-19 mortality in the United States: Evidence based on a meta-analysis

“…After evaluating and assessing as much as 257 potential studies, 201 studies were removed due to outcome of interest being not available. In the end, what underlay this meta-analysis were eligible fifty-six articles with 426,261 COVID-19 patients [5] , [6] , [7] , [8] , [9] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] . The detail of selection process is shown by a chart flow in Figure 1 .…”

An Observational Study on the Effects of Improvised Cpap (Icpap) in Cardiovascular Diseases With Acute Respiratory Failure

“…This emulates observations globally; for instance, a multicenter cohort study across 5 hospitals (March-April 2020) reported that 83% patients of those IMV died, while only 32% in the NIV subset died (unadjusted OR=10, 95% CI 6.7-17). 19 In a case series reported by Chand et al 274 (91.3%) patients received IMV; and 55.8% died, and 26 patients managed with a HFNC had a much lower 30-day mortality (15.4%). 21 In a systematic review and meta-analysis of 10,150 patients across Asia, Europe and North America, Armstrong et al describe a combined ICU mortality of 41.6% (34.0-49.7%), with a reduction over time seen in post-hoc analysis.…”

“…18 Later, in March-April 2020, in an audit on 688 patients, Forrest et al reported that as many as 78% received NIV, while 22% received IMV. 19 And in China, 17.6% (of 239) patients were described to receive IMV, whilst 52.1% received NIV. 20 In our cohort, 64.3% received NIV, and 16.5% were intubated (IMV).…”

High-Flow Nasal Oxygen and Noninvasive Ventilation for COVID-19

“…Although the multivariable regression attempted to address bias inherent in this nonrandomized study, it is not clear whether the higher mortality in this study reflects severity of illness in those intubated or a true cause and effect. 45 In patients with confirmed COVID-19 treated in respiratory units outside the ICU with either HFNO (n 5 163, 24.3%) or CPAP/NIV (n 5 507, 75.7%), the intubation rate was similar in the 2 groups, but the mortality was lower in the HFNO group. 36 In an interim analysis of the international, multicenter HOPE COVID-19 cohort (1933 patients), 390 (20%) patients were treated with NIV, 44.4% of whom had the composite outcome of death or need for intubation.…”