Timing and Outcomes of Noninvasive Ventilation in 307 ARDS COVID-19 Patients: An Observational Study in an Italian Third Level COVID-19 Hospital

Nardi Tetaj; Pierluca Piselli; Sara Zito; Giada De Angelis; Maria Cristina Marini; Dorotea Rubino; Ilaria Gaviano; Maria Vittoria Antonica; Elisabetta Agostini; Candido Porcelli; Giulia Valeria Stazi; Gabriele Garotto; Donatella Busso; Silvana Scarcia; Assunta Navarra; Claudia Cimaglia; Simone Topino; Fabio Iacomi; Alessandra D'Abramo; Carmela Pinnetti; Gina Gualano; Alessandro Capone; Alberta Villanacci; Andrea Antinori; Fabrizio Palmieri; Gianpiero D'Offizi; Stefania Ianniello; Fabrizio Taglietti; Paolo Campioni; Francesco Vaia; Emanuele Nicastri; Enrico Girardi; Luisa Marchioni; On Behalf Of The ReCOVeRI Study Group

doi:10.3390/medicina58081104

Timing and Outcomes of Noninvasive Ventilation in 307 ARDS COVID-19 Patients: An Observational Study in an Italian Third Level COVID-19 Hospital

Medicina (Kaunas). 2022 Aug 15;58(8):1104. doi: 10.3390/medicina58081104.

Authors

Nardi Tetaj¹, Pierluca Piselli², Sara Zito¹, Giada De Angelis¹, Maria Cristina Marini¹, Dorotea Rubino¹, Ilaria Gaviano¹, Maria Vittoria Antonica¹, Elisabetta Agostini¹, Candido Porcelli¹, Giulia Valeria Stazi¹, Gabriele Garotto¹, Donatella Busso¹, Silvana Scarcia¹, Assunta Navarra², Claudia Cimaglia², Simone Topino³, Fabio Iacomi³, Alessandra D'Abramo³, Carmela Pinnetti³, Gina Gualano⁴, Alessandro Capone³, Alberta Villanacci⁵, Andrea Antinori³, Fabrizio Palmieri⁴, Gianpiero D'Offizi³, Stefania Ianniello⁵, Fabrizio Taglietti³, Paolo Campioni⁵, Francesco Vaia⁶, Emanuele Nicastri³, Enrico Girardi⁷, Luisa Marchioni¹, On Behalf Of The ReCOVeRI Study Group

Affiliations

¹ UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy.
² Department of Epidemiology, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy.
³ Clinical and Research Department of Infectious Diseases, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy.
⁴ Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy.
⁵ Department of Radiology and Diagnostic Imaging, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy.
⁶ Health and General Direction, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy.
⁷ Scientific Direction, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy.

Abstract

Background and Objectives: Background: Coronavirus disease 2019 (COVID-19) is a novel cause of Acute Respiratory Distress Syndrome (ARDS). Noninvasive ventilation (NIV) is widely used in patients with ARDS across several etiologies. Indeed, with the increase of ARDS cases due to the COVID-19 pandemic, its use has grown significantly in hospital wards. However, there is a lack of evidence to support the efficacy of NIV in patients with COVID-19 ARDS. Materials and Methods: We conducted an observational cohort study including adult ARDS COVID-19 patients admitted in a third level COVID-center in Rome, Italy. The study analyzed the rate of NIV failure defined by the occurrence of orotracheal intubation and/or death within 28 days from starting NIV, its effectiveness, and the associated relative risk of death. The factors associated with the outcomes were identified through logistic regression analysis. Results: During the study period, a total of 942 COVID-19 patients were admitted to our hospital, of which 307 (32.5%) presented with ARDS at hospitalization. During hospitalization 224 (23.8%) were treated with NIV. NIV failure occurred in 84 (37.5%) patients. At 28 days from starting NIV, moderate and severe ARDS had five-fold and twenty-fold independent increased risk of NIV failure (adjusted odds ratio, aOR = 5.01, 95% CI 2.08−12.09, and 19.95, 95% CI 5.31−74.94), respectively, compared to patients with mild ARDS. A total of 128 patients (13.5%) were admitted to the Intensive Care Unit (ICU). At 28-day from ICU admission, intubated COVID-19 patients treated with early NIV had 40% lower mortality (aOR 0.60, 95% CI 0.25−1.46, p = 0.010) compared with patients that underwent orotracheal intubation without prior NIV. Conclusions: These findings show that NIV failure was independently correlated with the severity category of COVID-19 ARDS. The start of NIV in COVID-19 patients with mild ARDS (P/F > 200 mmHg) appears to increase NIV effectiveness and reduce the risk of orotracheal intubation and/or death. Moreover, early NIV (P/F > 200 mmHg) treatment seems to reduce the risk of ICU mortality at 28 days from ICU admission.

Keywords: ARDS; COVID-19; NIV failure; acute respiratory distress syndrome; intensive care unit; noninvasive ventilation; orotracheal intubation.

Publication types

Observational Study

MeSH terms

Adult
COVID-19* / complications
Cohort Studies
Hospitals
Humans
Intensive Care Units
Noninvasive Ventilation*
Pandemics
Respiratory Distress Syndrome* / etiology
Respiratory Distress Syndrome* / therapy
Respiratory Insufficiency* / etiology

Grants and funding

This work was supported by INMI Lazzaro Spallanzani Ricerca Finalizzata COVID-2020-12371675 and Ricerca Corrente on emerging infections (Linea 1), both funded by the Italian Ministry of Health.