Outcomes of COVID-19 patients intubated after failure of non-invasive ventilation: a multicenter observational study

Annalisa Boscolo,Giuseppe Gagliardi,Enrico Petranzan,Walter Mosaner,Mauro Antonio Calò,Massimo Zamperini,Paride Trevisiol,Alessandra Gadaldi,Fabio Toffoletto,Paolo Persona,Moreno Agostini,Sonila Vathi,Paolo Zanatta,Ivan Martinello,Ezio Sinigaglia,Camilla Sgarabotto,Davide Fregolent,Alessandra Tresin,Arianna Peralta,Ivan Daroui,Alessandro De Cassai,Rosalba Lembo,Daria Sartori,Laura Frigo,Luisa Muraro,Michele Della Paolera,Francesco Papaccio,Nicola Franchetti,Ottavia Bond,Luigi Ongaro,Demetrio Pittarello,Flavio Badii,Enrico Bosco,Mario Peta,Lorella Altafini,Elisa Pistollato,Chiara Schiavolin,Silvia Bassanini,Ilaria Valeri,Eugenio Serra,Ivo Tiberio,Alessandra Parnigotto,Vinicio Danzi,Aldo Schiavi,Christelle Correale,Silvia De Rosa,Elisa Michieletto,Francesco Montacciani,Alice Sorgato,Giorgio Fullin,Roberto Pianon,Davide Marchesin,Alfeo Bonato,Simonetta Marchiotto,Matteo Perona,Lorenzo Bernardi,Tommaso Pettenuzzo,Paolo Rosi,Francesco Zarantonello,Caterina Simoni,Giulio Andreatta,Gian Lorenzo Golino,Nicolò Brumana,Edoardo Forin,Federico Linassi,Antonio Farnia,Fabio Baratto,Alessandra Da Ros,Pier Francesco Pirelli,Ferraro Gioconda,Marco Baiocchi,Leonardo Gandolfi,Francesco Lazzari,Tatiana Falcioni,Marco Meggiolaro,Nicolò Sella,Laura Pasin,Katia Donadello,Enrico Polati,Andrea Vianello,Chiara Pretto,Leonardo Gottin,Alessandro Di Graziano ,Enrico Tamburini,Martina Tocco,Giovanni Landoni,Paolo Navalesi

doi:10.1038/s41598-021-96762-1

Abstract

The efficacy of non-invasive ventilation (NIV) in acute respiratory failure secondary to SARS-CoV-2 infection remains controversial. Current literature mainly examined efficacy, safety and potential predictors of NIV failure provided out of the intensive care unit (ICU). On the contrary, the outcomes of ICU patients, intubated after NIV failure, remain to be explored. The aims of the present study are: (1) investigating in-hospital mortality in coronavirus disease 2019 (COVID-19) ICU patients receiving endotracheal intubation after NIV failure and (2) assessing whether the length of NIV application affects patient survival. This observational multicenter study included all consecutive COVID-19 adult patients, admitted into the twenty-five ICUs of the COVID-19 VENETO ICU network (February–April 2020), who underwent endotracheal intubation after NIV failure. Among the 704 patients admitted to ICU during the study period, 280 (40%) presented the inclusion criteria and were enrolled. The median age was 69 [60–76] years; 219 patients (78%) were male. In-hospital mortality was 43%. Only the length of NIV application before ICU admission (OR 2.03 (95% CI 1.06–4.98), p = 0.03) and age (OR 1.18 (95% CI 1.04–1.33), p < 0.01) were identified as independent risk factors of in-hospital mortality; whilst the length of NIV after ICU admission did not affect patient outcome. In-hospital mortality of ICU patients intubated after NIV failure was 43%. Days on NIV before ICU admission and age were assessed to be potential risk factors of greater in-hospital mortality.

Highlights

The efficacy of non-invasive ventilation (NIV) in acute respiratory failure secondary to SARS-CoV-2 infection remains controversial
Data prospectively collected from a total of 704 consecutive patients with confirmed SARS-CoV-2 infection, admitted into the twenty-five intensive care unit (ICU) belonging to COVID-19 VENETO ICU Network from February 28 to April 28, 202012, were screened for inclusion criteria
Length of NIV application outside the ICU exceeding 48 h and age above 73 years were associated with greater mortality

Summary

Introduction

The efficacy of non-invasive ventilation (NIV) in acute respiratory failure secondary to SARS-CoV-2 infection remains controversial. The aims of the present study are: (1) investigating in-hospital mortality in coronavirus disease 2019 (COVID-19) ICU patients receiving endotracheal intubation after NIV failure and (2) assessing whether the length of NIV application affects patient survival. This observational multicenter study included all consecutive COVID-19 adult patients, admitted into the twenty-five ICUs of the COVID-19 VENETO ICU network (February–April 2020), who underwent endotracheal intubation after NIV failure. The efficacy of non-invasive ventilation (NIV), including both Biphasic Positive Airway Pressure (BiPAP) and non-invasive Continuous Positive Airway Pressure (CPAP), in patients with acute respiratory failure (ARF) secondary to coronavirus disease 2019 (COVID-19) is still d ebated[1,2]. Solid evidence in favor of early intubation in COVID-19 ARF is still lacking, as several investigations failed to reveal a significant difference in mortality according to the time of intubation[4,5]

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