Noninvasive Ventilatory Support of COVID-19 Patients Outside the Intensive Care Units (WARd-COVID)

Giacomo Bellani, Giacomo Grasselli, Maurizio Cecconi, Laura Antolini, Massimo Borelli, Federica De Giacomi, Giancarlo Bosio, Nicola Latronico, Matteo Filippini, Marco Gemma, Claudia Giannotti, Benvenuto Antonini, Nicola Petrucci, Simone Maria Zerbi, Paolo Maniglia, Gian Paolo Castelli, Giovanni Marino, Matteo Subert, Giuseppe Citerio, Danilo Radrizzani, Teresa S Mediani, Ferdinando Luca Lorini, Filippo Maria Russo, Angela Faletti, Andrea Beindorf, Remo Daniel Covello, Stefano Greco, Marta M Bizzarri, Giuseppe Ristagno, Francesco Mojoli, Andrea Pradella, Paolo Severgnini, Marta Da Macallè, Andrea Albertin, V Marco Ranieri, Emanuele Rezoagli, Giovanni Vitale, Aurora Magliocca, Gianluca Cappelleri, Mattia Docci, Stefano Aliberti, Filippo Serra, Emanuela Rossi, Maria Grazia Valsecchi, Antonio Pesenti, Giuseppe Foti
Annals of the American Thoracic Society 2021 January 4

RATIONALE: Treatment with non-invasive ventilation (NIV) in COVID-19 is frequent. Shortage of Intensive care unit (ICU) beds led clinicians to deliver NIV also outside intensive care units (ICUs). Data about the use of NIV in COVID-19 is limited.

OBJECTIVE: To describe the prevalence and clinical characteristics of patients with COVID-19 treated with NIV outside the ICUs. To investigate the factors associated with NIV failure (need for intubation or death).

METHODS: In this prospective single day observational study, we enrolled adult COVID-19 patients, treated with NIV outside the ICU from thirty-one hospitals in Lombardy, Italy.

RESULTS: We collected data on demographic, clinical characteristics, ventilatory management and patients' outcome. Of 8753 COVID-19 patients present in the hospitals on the study day, 909 (10%) were receiving NIV outside the ICU. 778/909 (85%) patients were treated with Continuous Positive Airway Pressure (CPAP), delivered by helmet in 617 (68%). NIV failed in 300 patients (37.6%), while 498 (62.4%) were discharged alive without intubation. Overall mortality was 25%. NIV failure occurred in 152/284 (53%) patients with a PaO2/FiO2 ratio < 150 mmHg. Higher C-reactive protein, lower PaO2/FiO2, and platelet counts were independently associated with increased risk of NIV failure.

CONCLUSIONS: The use of NIV outside the ICUs, in COVID-19 was common, with a predominant use of helmet CPAP, with a rate of success greater than 60% and close to 75% in full treatment patients. C-reactive protein, PaO2/FiO2, platelet counts were independently associated with increased risk of NIV failure. Clinical trial registered with (NCT04382235).

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