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Panminerva Medica 2021 Apr 16

DOI: 10.23736/S0031-0808.21.04280-4

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Outcomes of non-invasive ventilation as the ceiling of treatment in patients with COVID-19

Giuseppe A. RAMIREZ 1, 2 , Enrica P. BOZZOLO 3, Agnese GOBBI 2, 3, Elena CASTELLI 4, Clarissa CENTURIONI 2, 3, Mattia DI MEO 4, Emanuel DELLA TORRE 1, 2, Flavia DI SCALA 2, 3, Anna MORGILLO 2, 3, Alessandro MARINOSCI 3, Martina MIGLIO 2, Paolo SCARPELLINI 5, Chiara TASSAN DIN 5, Barbara CASTIGLIONI 5, Chiara OLTOLINI 5, Marco RIPA 5, Gaetano DI TERLIZZI 3, Valentina DA PRAT 3, Sarah DAMANTI 3, Raffaella SCOTTI 3, Giuseppe DI LUCCA 3, Martina BAIARDO REDAELLI 6, Valentina P. PLUMARI 6, Elena MOIZO 6, Francesco CARCÓ 6, Paolo SILVANI 6, Francesco DE COBELLI 7, Giovanni LANDONI 2, 6, Moreno TRESOLDI 3, for the COVID-BioB group 

1 Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; 2 Vita-Salute San Raffaele University, Milan, Italy; 3 Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; 4 Cardiothoracic Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; 5 Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; 6 Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; 7 Unit of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy



BACKGROUND: Non-invasive mechanical ventilation (NIV) is effective for symptom relief and respiratory support in patients with respiratory insufficiency, severe comorbidities and no indication to intubation. Experience with NIV as the ceiling of treatment in severely compromised novel coronavirus disease (COVID-19) patients is lacking.
METHODS: We evaluated 159 patients with COVID-19-related acute respiratory syndrome (ARDS), 38 of whom with NIV as the ceiling of treatment, admitted to an ordinary ward and treated with continuous positive airway pressure (CPAP) and respiratory physiotherapy. Treatment failure and death were correlated with clinical and laboratory parameters in the whole cohort and in patients with NIV as the ceiling of treatment.
RESULTS: Patients who had NIV as the ceiling of treatment were elderly, with a low BMI and a high burden of comorbidities, showed clinical and laboratory signs of multi-organ insufficiency on admission and of rapidly deteriorating vital signs during the first week of treatment. NIV failure occurred overall in 77 (48%) patients, and 27/38 patients with NIV as the ceiling of treatment died. Congestive heart failure, chronic benign haematological diseases and inability/refusal to receive respiratory physiotherapy were independently associated to NIV failure and mortality. Need for increased positive end-expiratory pressures and low platelets were associated with NIV failure. Death was associated to cerebrovascular disease, need for CPAP cycles longer than 12h and, in the subgroup of patients with NIV as the ceiling of treatment, was heralded by vital sign deterioration within 48 h.
CONCLUSIONS: NIV and physiotherapy are a viable treatment option for patients with severe COVID-19 and severe comorbidities.


KEY WORDS: Coronavirus; COVID-19; Non-invasive ventilation; Ceiling of treatment; CPAP; Respiratory physiotherapy; Pronation

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