High failure rate of noninvasive oxygenation strategies in critically ill subjects with acute hypoxemic respiratory failure due to covid-19

Luca Salvatore Menga, Luca Delle Cese, Filippo Bongiovanni, Gianmarco Lombardi, Teresa Michi, Filippo Luciani, Marta Cicetti, Jacopo Timpano, Maria Cristina Ferrante, Melania Cesarano, Gian Marco Anzellotti, Tommaso Rosà, Daniele Natalini, Eloisa S. Tanzarella, Salvatore Lucio Cutuli, Gabriele Pintaudi, Gennaro De Pascale, Antonio M. Dell’anna, Giuseppe Bello, Mariano Alberto PennisiSalvatore Maurizio Maggiore, Riccardo Maviglia, Domenico Luca Grieco, Massimo Antonelli

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: The efficacy of noninvasive oxygenation strategies (NIOS) in treating COVID-19 disease is unknown. We conducted a prospective observational study to assess the rate of NIOS failure in subjects treated in the ICU for hypoxemic respiratory failure due to COVID-19. METHODS: Patients receiving first-line treatment NIOS for hypoxemic respiratory failure due to COVID-19 in the ICU of a university hospital were included in this study; laboratory data were collected upon arrival, and 28-d outcome was recorded. After propensity score matching based on Simplified Acute Physiology (SAPS) II score, age, PaO2 =FIO2 and PaCO2 at arrival, the NIOS failure rate in subjects with COVID-19 was compared to a previously published cohort who received NIOS during hypoxemic respiratory failure due to other causes. RESULTS: A total of 85 subjects received first-line treatment with NIOS. The most frequently used methods were helmet noninvasive ventilation and highflow nasal cannula; of these, 52 subjects (61%) required endotracheal intubation. Independent factors associated with NIOS failure were SAPS II score (P 5 .009) and serum lactate dehydrogenase at enrollment (P 5 .02); the combination of SAPS II score 6 33 with serum lactate dehydrogenase 6 405 units/L at ICU admission had 91% specificity in predicting the need for endotracheal intubation. In the propensity-matched cohorts (54 pairs), subjects with COVID-19 showed higher risk of NIOS failure than those with other causes of hypoxemic respiratory failure (59% vs 35%, P 5 .02), with an adjusted hazard ratio of 2 (95% CI 1.1–3.6, P 5 .01). CONCLUSIONS: As compared to hypoxemic respiratory failure due to other etiologies, subjects with COVID-19 who were treated with NIOS in the ICU were burdened by a 2-fold higher risk of failure. Subjects with a SAPS II score 6 33 and serum lactate dehydrogenase 6 405 units/L represent the population with the greatest risk.

Original languageEnglish
Pages (from-to)705-714
Number of pages10
JournalRespiratory Care
Volume66
Issue number5
DOIs
Publication statusPublished - May 1 2021

Keywords

  • COVID-19
  • Noninvasive ventilation
  • Positive-pressure ventilation
  • Respiratory failure

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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