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Minerva Medica 2021 Jan 19

DOI: 10.23736/S0026-4806.21.07134-2


language: English

Management of patients with severe acute respiratory failure due to SARSCoV-2 pneumonia with non-invasive 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 5, Alessandro PERAZZO 6, Cornelius BARLASCINI 7, Armando BAULEO 8, Antonello NICOLINI 6 , Paolo SOLIDORO 9, 10

1 Pulmonary-Sleep Disorders and Non Invasive Ventilation Unit, Hospital Marqués de Valdecilla, Santander, Spain; 2 Rehabilitation Pulmonology, Don Gnocchi Foundation, IRCCS, Milan, Italy; 3 Pulmonology Unit, Santa Maria Bianca Hospital, Mirandola,Modena, Italy; 4 Covid RICU, General Hospital, Sestri Levante, Genova, Italy; 5 Covid ICU, General Hospital, Sestri Levante, Genova, Italy; 6 Respiratory Diseases Unit, General Hospital, Sestri Levante, Genova, Italy; 7 Hygiene and Health Care Medicine, General Hospital, Sestri Levante, Genova, Italy; 8 Sophia Genetics, Saint Sulpice, Switzerland; 9 Cardiovascular and Thoracic Department, Respiratory Diseases Unit U, AOU Città della Salute e della Scienza, Turin, Italy; 10 Medical Science Department, 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 is evaluating the management of severe ARF due to COVID-19 pneumonia using non-invasive ventilatory support (NIVS), studing safety and effectiveness of non-invasive ventilatory support (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:162 patients were hospitalized because of severe respiratory failure ( PaO2/FiO2 ratio < 250 ). 138 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, PaCO2, 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 patient.

KEY WORDS: COVID 19 related pneumonia; Acute respiratory failure; Non-invasive ventilatory support; Hospital mortality

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