Non-invasive ventilation for SARS-CoV-2 acute respiratory failure: a subanalysis from the HOPE COVID-19 registry

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Abstract

Background

The COVID-19 pandemic has seriously challenged worldwide healthcare systems and limited intensive care facilities, leading to physicians considering the use of non-invasive ventilation (NIV) for managing SARS-CoV-2-related acute respiratory failure (ARF).

Methods

We conducted an interim analysis of the international, multicentre HOPE COVID-19 registry including patients admitted for a confirmed or highly suspected SARS-CoV-2 infection until 18 April 2020. Those treated with NIV were considered. The primary endpoint was a composite of death or need for intubation. The components of the composite endpoint were the secondary outcomes. Unadjusted and adjusted predictors of the primary endpoint within those initially treated with NIV were investigated.

Results

1933 patients who were included in the registry during the study period had data on oxygen support type. Among them, 390 patients (20%) were treated with NIV. Compared with those receiving other non-invasive oxygen strategy, patients receiving NIV showed significantly worse clinical and laboratory signs of ARF at presentation. Of the 390 patients treated with NIV, 173 patients (44.4%) met the composite endpoint. In-hospital death was the main determinant (147, 37.7%), while 62 patients (15.9%) needed invasive ventilation. Those requiring invasive ventilation had the lowest survival rate (41.9%). After adjustment, age (adjusted OR (adj(OR)) for 5-year increase: 1.37, 95% CI 1.15 to 1.63, p<0.001), hypertension (adj(OR) 2.95, 95% CI 1.14 to 7.61, p=0.03), room air O ₂ saturation <92% at presentation (adj(OR) 3.05, 95% CI 1.28 to 7.28, p=0.01), lymphocytopenia (adj(OR) 3.55, 95% CI 1.16 to 10.85, p=0.03) and in-hospital use of antibiotic therapy (adj(OR) 4.91, 95% CI 1.69 to 14.26, p=0.003) were independently associated with the composite endpoint.

Conclusion

NIV was used in a significant proportion of patients within our cohort, and more than half of these patients survived without the need for intubation. NIV may represent a viable strategy particularly in case of overcrowded and limited intensive care resources, but prompt identification of failure is mandatory to avoid harm. Further studies are required to better clarify our hypothesis.

Trial registration numbers

NCT04334291/EUPAS34399.

Related collections

Most cited references 30

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Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Chaolin Huang, Yeming Wang, Xingwang Li … (2020)

Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.

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Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

Dawei Wang, Bo Hu, Fangfang Zhu … (2020)

In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.

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Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

Nanshan Chen, Min Zhou, Xuan Dong … (2022)

Summary Background In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. We aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia. Methods In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data. Outcomes were followed up until Jan 25, 2020. Findings Of the 99 patients with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 55·5 years (SD 13·1), including 67 men and 32 women. 2019-nCoV was detected in all patients by real-time RT-PCR. 50 (51%) patients had chronic diseases. Patients had clinical manifestations of fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). According to imaging examination, 74 (75%) patients showed bilateral pneumonia, 14 (14%) patients showed multiple mottling and ground-glass opacity, and one (1%) patient had pneumothorax. 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure. Interpretation The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection. Funding National Key R&D Program of China.

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Author and article information

Journal

Journal ID (nlm-ta): Emerg Med J

Journal ID (iso-abbrev): Emerg Med J

Journal ID (hwp): emermed

Journal ID (publisher-id): emj

Title: Emergency Medicine Journal : EMJ

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Print): 1472-0205

ISSN (Electronic): 1472-0213

Publication date (Print): March 2021

Publication date (Electronic): 16 March 2021

Electronic Location Identifier: emermed-2020-210411

Affiliations

[1 ]departmentDepartment of Cardiology , San Giovanni Bosco Hospital , Turin, Piemonte, Italy

[2 ]departmentEmergency Medicine Department , Martini Hospital Centre , Torino, Piemonte, Italy

[3 ]departmentCardiovascular Institute , Hospital Clinico San Carlos , Madrid, Community of Madrid, Spain

[4 ]departmentDivision of Cardiology, Cardiovascular and Thoracic Department , University Hospital Città della Salute e della Scienza , Turin, Italy

[5 ]departmentCardiology Department , Severo Ochoa University Hospital , Leganes, Madrid, Spain

[6 ]departmentDepartment of Cardiology , General University Hospital of Guadalajara , Guadalajara, Castilla-La Mancha, Spain

[7 ]departmentServicio de Urgencias , Getafe University Hospital , Getafe, Community of Madrid, Spain

[8 ]departmentEmergency Department , La Paz University Hospital , Madrid, Spain

[9 ]departmentDivision of Cardiology , Valladolid University Clinical Hospital , Valladolid, Castilla y León, Spain

[10 ]departmentDivision of Cardiology , Virgen de la Victoria University Hospital , Malaga, Andalucía, Spain

[11 ]departmentDepartment of Critical Care Medicine , Shenzhen Second People's Hospital , Shenzhen, Guangdong, China

[12 ]departmentDivision of Cardiology , Institute of Cardiology and Cardiovascular Surgery , Havana, Cuba

[13 ]departmentInternal Medicine Department , Hospital General del norte de Guayaquil IESS Los Ceibos , Guayaquil, Ecuador

[14 ]departmentDivision of Cardiology , Sant'Andrea di Vercelli Hospital , Vercelli, Piedmont, Italy

[15 ]departmentDivision of Cardiology , San Luigi Gonzaga University Hospital , Orbassano, Italy

[16 ]departmentPulmonary Department , Hospital Clinico , Valencia, Spain

[17 ]departmentDivision of Cardiology , University Hospital Alvaro Cunqueiro , Vigo, Galicia, Spain

[18 ]departmentDivision of Cardiology , Hospital Nuestra Señora de América Madrid , Madrid, Spain

[19 ]Infanta Sofia University Hospital , San Sebastian de los Reyes, Community of Madrid, Spain

[20 ]departmentUniversity Medical Centre Mannheim , Heidelberg University , Mannheim, Germany

Author notes

[Correspondence to ] Dr Maurizio Bertaina, Department of Cardiology, San Giovanni Bosco Hospital, Torino, Piemonte 10154, Italy; maurizio.bertaina@ 123456gmail.com

Author information

Maurizio Bertaina http://orcid.org/0000-0001-5727-4107

Article

Publisher ID: emermed-2020-210411

DOI: 10.1136/emermed-2020-210411

PMC ID: 7970657

PubMed ID: 33727235

SO-VID: 02609e09-59da-4491-8ec2-51765aa67f51

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