Abstract
BackgroundThe role of non-invasive positive pressure ventilation (NIPPV) in COVID-19 patients with acute hypoxemic respiratory failure (AHRF) is uncertain. This study was aimed to assess the effectiveness and safety of NIPPV in patients with COVID-19-associated AHRF admitted to non-ICU wards.MethodsWe retrospectively evaluated all COVID-19 patients consecutively admitted to the COVID-19 general wards of a medium-size Italian hospital, from March 6 to May 7, 2020. Healthcare workers (HCWs) caring for COVID-19 patients were monitored, undergoing naso-pharyngeal swab for SARS-CoV-2 in case of onset of COVID-19 symptoms, and periodic SARS-CoV-2 screening serology.ResultsOverall, 50 of 143 patients (mean age 74.6 years) were treated with NIPPV, and 22 (44%) were successfully weaned. Due to limited life expectancy, 25 (50%) of 50 NIPPV-treated patients received a “do not intubate” order. Among these, only 6 (24%) were weaned from NIPPV. Of the remaining 25 NIPPV-treated patients, 16 (64%) were successfully weaned, 9 (36%) underwent delayed endotracheal intubation and, among these, 3 (33.3%) died. NIPPV success was predicted by the use of corticosteroids (OR 15.4, p 0.013), the PaO2/FiO2 ratio measured 24-48 hours after NIPPV initiation (OR 1.02, p 0.015), and the presence of a “do not intubate” order (OR 0.03, p 0.020). During the study period, 2 of 124 (1.6%) HCWs caring for COVID-19 patients were diagnosed with mild SARS-CoV-2 infection.ConclusionsApart from patients with limited life expectancy, NIPPV was effective in a substantially high percentage of patients with COVID-19-associated AHRF. The risk of SARS-CoV-2 infection among HCWs was low.
Effectiveness and safety of non-invasive positive pressure ventilation in the treatment of COVID-19-associated acute hypoxemic respiratory failure: a single center, non-ICU setting experience.
