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Minerva Medica 2021 June;112(3):329-37

DOI: 10.23736/S0026-4806.21.07134-2


language: English

Management of patients with severe acute respiratory failure due to SARS-CoV-2 pneumonia with noninvasive ventilatory support outside Intensive Care Unit

Teresa DIAZ DE TERAN 1, Monica GONZALES MARTINEZ 1, Paolo BANFI 2, Giancarlo GARUTI 3, Gianluca FERRAIOLI 4, Giuseppe RUSSO 4, Francesco CASU 4, Michela VIVARELLI 4, Monica BONFIGLIO 4, Alessandro PERAZZO 5, Cornelius BARLASCINI 6, Armando BAULEO 7, Antonello NICOLINI 5 , Paolo SOLIDORO 8, 9

1 Unit of Pulmonary Sleep Disorders and Noninvasive Ventilation, Marqués de Valdecilla Hospital, Santander, Spain; 2 Unit of Rehabilitation Pulmonology, IRCCS Don Gnocchi Foundation, Milan, Italy; 3 Unit of Pulmonology, Santa Maria Bianca Hospital, Mirandola, Modena, Italy; 4 COVID Respiratory Intensive Care Unit, General Hospital, Sestri Levante, Genoa, Italy; 5 Unit of Respiratory Diseases, General Hospital, Sestri Levante, Genoa, Italy; 6 Unit of Hygiene and Health Care Medicine, General Hospital, Sestri Levante, Genoa, Italy; 7 Independent Scientific Consultant, Modena, Italy; 8 Unit of Respiratory Diseases, Department Cardiovascular and Thoracic Diseases, Città della Salute e della Scienza, Turin, Italy; 9 Department of Medical Science, University of Turin, Turin, Italy

BACKGROUND: COVID-19 has high mortality rate mainly stemming from acute respiratory distress leading to respiratory failure (ARF). Aim of the study was to evaluate the management of severe ARF due to COVID-19 pneumonia using noninvasive ventilatory support (NIVS), studying safety and effectiveness of NIVS.
METHODS: This is a retrospective, multicenter study. Primary outcomes were NIVS failure with intubation rate and hospital mortality. Secondary outcomes were hospital stay and factors related to NIVS failure and mortality. These outcomes were compared with patients intubated and admitted to ICU.
RESULTS: One hundred sixty-two patients were hospitalized because of severe respiratory failure (PaO2/FiO2 ratio <250). One hundred thirty-eight patients were admitted to Respiratory Intermediate Care Unit (RICU) for a NIVS trial. One hundred patients were treated successfully with NIVS (74.5%); 38 failed NIVS trial (27.5%). In-hospital mortality was 23.18% in RICU group and 30.55% in ICU group. Patients with NIVS failure were older, had a lower number of lymphocytes, a higher IL-6, lower PaO2, PaC O2, PaO2/FiO2 ratio, higher respiratory rate (RR) and heart rate at admission and lower PaO2, and PaO2/FiO2 ratio and higher RR after 1-6 hours. Multivariate analysis identified higher age, C-reactive protein as well as RR after 1-6 hours and PaO2/FiO2 ratio after 1-6 hours as an independent predictor mortality.
CONCLUSIONS: NIVS is a safe and effective strategy in the treatment of severe ARF due to COVID-19 related pneumonia, that reduces mortality and length of hospital stay in the carefully selected patients.

KEY WORDS: COVID-19; Respiratory insufficiency; Hospital mortality

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