Predictors of intubation in COVID-19 patients treated with out-of-ICU continuous positive airway pressure

De Vita, N.; Scotti, L.; Cammarota, G.; Racca, F.; Pissaia, C.; Maestrone, C.; Colombo, D.; Olivieri, C.; Della Corte, F.; Barone-Adesi, F.; Navalesi, P.; Vaschetto, R.

BACKGROUND: As delayed intubation may worsen the outcome of coronavirus disease 2019 (COVID-19) patients treated with continuous positive airway pressure (CPAP), we sought to determine COVID-specific early predictors of CPAP failure. METHODS: In this observational retrospective multicentre study, we included all COVID-19 patients treated with out-of-ICU CPAP, candidates for intubation in case of CPAP failure. From these patients, we collected demographic and clinical data. RESULTS: A total of 397 COVID-19 patients were treated with CPAP for respiratory failure, with the therapeutic goal of providing intubation in case of CPAP failure. Univariable analysis showed that, age, lactate dehydrogenase (LDH) and white cell counts were all significantly lower in patients with successful CPAP treatment compared to those failing it and undergoing subsequent intubation. The percentage changes between baseline and CPAP application in the ratio of partial pressure arterial oxygen (PaO(2)) and fraction of inspired oxygen (FiO(2)), PaO(2,) respiratory rate and ROX index were higher in patients experiencing successful CPAP compared to those failing it. FiO(2) and male gender were also significantly associated with intubation. Multivariable analysis adjusting for age, gender, Charlson Comorbidity Index, percentage change in PaO(2)/FiO(2) or PaO(2) and FiO(2) separately, lactate, white blood cell count, LDH and C-reactive protein levels led to an area under the curve of 0.818 and confirmed that age, LDH and percentage increase in PaO(2)/FiO(2) are predictors of intubation. CONCLUSIONS: In COVID-19 patients requiring CPAP, age, LDH and percentage change in PaO(2)/FiO(2) after starting CPAP are predictors of intubation.