Bilevel and continuous positive airway pressure and factors linked to all-cause mortality in COVID-19 patients in an intermediate respiratory intensive care unit in Italy

Expert Rev Respir Med. 2021 Jun;15(6):853-857. doi: 10.1080/17476348.2021.1866546. Epub 2020 Dec 23.

Abstract

Objectives: In the present single-centered, retrospective, observational study, we reported findings from 78 consecutive laboratory-confirmed COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS) hospitalized in an intermediate Respiratory Intensive Care Unit, subdividing the patients into two groups according to their clinical outcome, dead patients and discharged patients.Methods: We further subdivided patients depending on the noninvasive respiratory support used during hospitalization.Results: In those patients who died, we found significant older age and higher multimorbidity and higher values of serum lactate dehydrogenase, C-reactive protein, and D-dimer. Among patients who were submitted to bilevel positive airway pressure (BPAP), those who died had a significant shorter number of days in overall length of stay and lower values of arterial oxygen partial pressure to fractional inspired oxygen ratio (PaO2/FiO2 ratio) compared to those who survived. No difference in all-cause mortality was observed between the two different noninvasive respiratory support groups [48% for continuous positive airway pressure (CPAP) and 52% for BPAP].Conclusion: In COVID-19 patients with moderate-to-severe ARDS using BPAP in an intermediate level of hospital care had more factors associated to all-cause mortality (shorter length of stay and lower baseline PaO2/FiO2 ratio) compared to those who underwent CPAP.

Keywords: Critical care; SARS-CoV-2; assisted ventilation; intermediate RICU; respiratory infection; viral infection.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • COVID-19 / etiology
  • COVID-19 / mortality*
  • COVID-19 / pathology
  • COVID-19 / therapy*
  • Cause of Death
  • Comorbidity
  • Continuous Positive Airway Pressure / methods*
  • Critical Care / statistics & numerical data
  • Female
  • Hospital Mortality
  • Hospitalization / statistics & numerical data
  • Humans
  • Intensive Care Units / statistics & numerical data*
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Oxygen / therapeutic use
  • Respiratory Distress Syndrome / mortality
  • Respiratory Distress Syndrome / therapy
  • Respiratory Distress Syndrome / virology
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2 / physiology

Substances

  • Oxygen

Grants and funding

This paper was not funded.