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Observational Study
. 2021 Jun;18(6):1020-1026.
doi: 10.1513/AnnalsATS.202008-1080OC.

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

Giacomo Bellani  1   2 , Giacomo Grasselli  3   4 , Maurizio Cecconi  5   6 , Laura Antolini  1 , Massimo Borelli  7 , Federica De Giacomi  8 , Giancarlo Bosio  8 , Nicola Latronico  9   10 , Matteo Filippini  10 , Marco Gemma  11 , Claudia Giannotti  12 , Benvenuto Antonini  13 , Nicola Petrucci  14 , Simone Maria Zerbi  15 , Paolo Maniglia  16 , Gian Paolo Castelli  17 , Giovanni Marino  18 , Matteo Subert  19 , Giuseppe Citerio  1   2   20 , Danilo Radrizzani  21 , Teresa S Mediani  22 , Ferdinando Luca Lorini  23 , Filippo Maria Russo  23 , Angela Faletti  24 , Andrea Beindorf  25 , Remo Daniel Covello  26 , Stefano Greco  27 , Marta M Bizzarri  28 , Giuseppe Ristagno  3 , Francesco Mojoli  29 , Andrea Pradella  5 , Paolo Severgnini  30 , Marta Da Macallè  30 , Andrea Albertin  31 , V Marco Ranieri  32 , Emanuele Rezoagli  1   2   33 , Giovanni Vitale  33 , Aurora Magliocca  1   33 , Gianluca Cappelleri  34 , Mattia Docci  1   35 , Stefano Aliberti  4   36 , Filippo Serra  1 , Emanuela Rossi  1 , Maria Grazia Valsecchi  1 , Antonio Pesenti  3   4 , Giuseppe Foti  1   2
Affiliations
Observational Study

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

Giacomo Bellani et al. Ann Am Thorac Soc. 2021 Jun.

Abstract

Rationale: Treatment with noninvasive ventilation (NIV) in coronavirus disease (COVID-19) is frequent. Shortage of intensive care unit (ICU) beds led clinicians to deliver NIV also outside ICUs. Data about the use of NIV in COVID-19 is limited.Objectives: 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 patients with COVID-19 who were treated with NIV outside the ICU from 31 hospitals in Lombardy, Italy.Results: We collected data on demographic and clinical characteristics, ventilatory management, and patient outcomes. Of 8,753 patients with COVID-19 present in the hospitals on the study day, 909 (10%) were receiving NIV outside the ICU. A majority of patients (778/909; 85%) patients were treated with continuous positive airway pressure (CPAP), which was delivered by helmet in 617 (68%) patients. NIV failed in 300 patients (37.6%), whereas 498 (62.4%) patients were discharged alive without intubation. Overall mortality was 25%. NIV failure occurred in 152/284 (53%) patients with an arterial oxygen pressure (PaO2)/fraction of inspired oxygen (FiO2) ratio <150 mm Hg. Higher C-reactive protein and lower PaO2/FiO2 and platelet counts were independently associated with increased risk of NIV failure.Conclusions: The use of NIV outside the ICUs was common in COVID-19, with a predominant use of helmet CPAP, with a rate of success >60% and close to 75% in full-treatment patients. C-reactive protein, PaO2/FiO2, and platelet counts were independently associated with increased risk of NIV failure.Clinical trial registered with ClinicalTrials.gov (NCT04382235).

Keywords: COVID-19; coronavirus; noninvasive ventilatory support.

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Figures

Figure 1.
Figure 1.
Survival curves of patients with coronavirus disease (COVID-19) treated with noninvasive ventilation and stratified according to PaO2/Fi O2 ratio on the date of data collection. Log-rank test, P < 0.001. Fi O2 = fraction of inspired oxygen; PaO2 = arterial oxygen pressure.
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