Noninvasive ventilation for acute hypoxemic respiratory failure in patients with COVID-19

Abstract

Aim

Noninvasive ventilation (NIV) is known to reduce intubation in patients with acute hypoxemic respiratory failure (AHRF) [ 1]. We aimed to assess the outcomes of NIV application in COVID-19 patients with AHRF.

Materials & methods

In this retrospective cohort study, patients with confirmed diagnosis of COVID-19 and AHRF receiving NIV in general wards were recruited from two university-affiliated hospitals. Demographic, clinical, and laboratory data were recorded at admission. The failure of NIV was defined as intubation or death during the hospital stay.

Results

Between April 8 and June 10, 2020, 61 patients were enrolled into the final cohort. NIV was successful in 44 out of 61 patients (72.1%), 17 patients who failed NIV therapy were intubated, and among them 15 died. Overall mortality rate was 24.6%. Patients who failed NIV were older, and had higher respiratory rate, PaCO ₂, D-dimer levels before NIV and higher minute ventilation and ventilatory ratio on the 1-st day of NIV. No healthcare workers were infected with SARS-CoV-2 during the study period.

Conclusions

NIV is feasible in patients with COVID-19 and AHRF outside the intensive care unit, and it can be considered as a valuable option for the management of AHRF in these patients.

Highlights

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  The use of NIV is feasible in COVID-19–associated AHRF outside intensive care unit and its application can be considered as a valuable option for the management of AHRF.

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  Elevated D-dimer levels, higher minute ventilation and ventilatory ratio during NIV were independently associated with NIV failure.

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  Caring for COVID-19 patients during NIV with appropriate PPE can avoid nosocomial infections with SARS-CoV-2 in health care workers.