Clinical Outcomes in Patients Aged 80 Years or Older Receiving Non-Invasive Respiratory Support for Hypoxemic Acute Respiratory Failure Consequent to COVID-19.

Andrea Vianello,Carlo Olivieri,Beatrice Molena,Valeria Bonato,Nello De Vita,Giovanna Arcaro,Pier Paolo Sainaghi,Rosanna Vaschetto,Gabriella Guarnieri,Paolo Navalesi,Gianluca Airoldi,Lorenza Scotti,Marco Confalonieri,Federico Lionello,Francesco Della Corte,Carlo Maestrone

doi:10.3390/jcm11051372

Abstract

As the clinical outcome of octogenarian patients hospitalised for COVID-19 is very poor, here we assessed the clinical characteristics and outcomes of patients aged 80 year or older hospitalised for COVID-19 receiving non-invasive respiratory support (NIRS). A multicentre, retrospective, observational study was conducted in seven hospitals in Northern Italy. All patients aged ≥80 years with COVID-19 associated hypoxemic acute respiratory failure (hARF) undergoing NIRS between 24 February 2020, and 31 March 2021, were included. Out of 252 study participants, 156 (61.9%) and 163 (64.6%) died during hospital stay and within 90 days from hospital admission, respectively. In this case, 228 (90.5%) patients only received NIRS (NIRS group), while 24 (9.5%) were treated with invasive mechanical ventilation (IMV) after NIRS failure (NIRS+IMV group). In-hospital mortality did not significantly differ between NIRS and NIRS+IMV group (61.0% vs. 70.8%, respectively; p = 0.507), while survival probability at 90 days was significantly higher for NIRS compared to NIRS+IMV patients (0.379 vs. 0.147; p = 0.0025). The outcome of octogenarian patients with COVID-19 receiving NIRS is quite poor. Caution should be used when considering transition from NIRS to IMV after NIRS failure.

Highlights

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which causes coronavirus disease 2019 (COVID-19), was declared a global pandemic by the WorldHealth Organization (WHO) on 11 March 2020
We aimed to describe the clinical characteristics and outcomes of patients aged 80 years or more hospitalized for COVID-19-associated hypoxemic acute respiratory failure (hARF) receiving non-invasive respiratory support (NIRS) at intermediate respiratory care units (IRCUs)
We retrospectively evaluated all patients aged ≥80 years diagnosed with severe pneumonia and laboratory confirmed SARS-CoV-2 infection [13] admitted to the IRCU of the participating hospitals for hARF who underwent continuous positive airway pressure (CPAP) or non-invasive positive pressure ventilation (NPPV) during the study period

Summary

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which causes coronavirus disease 2019 (COVID-19), was declared a global pandemic by the WorldHealth Organization (WHO) on 11 March 2020. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which causes coronavirus disease 2019 (COVID-19), was declared a global pandemic by the World. Disease severity from COVID-19 varies widely, and older adults are more likely to progress to severe disease, leading to high mortality rates [1]. In Italy, patients between 60–69, 80–89, and over 90 years old showed a case fatality rate (CFR) of 3.5%, 19.7%, and 22.7%, respectively [2,3]. During the first pandemic wave, in-hospital mortality rate in octogenarian COVID-19 patients in the New. York City area was about 54% [4]. In a similar cohort of patients in Spain, the mortality rate was 33.3% [5]. Frailty was independently associated with lower survival in a population of 1346 patients with a median age of 75 years admitted to ICUs from 28 countries [6]

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