Non-invasive Ventilation (NIV) in the Management of Respiratory Failure Due to COVID-19 Infection: Experience From a Resource Limited Setting

Chacko, Binila; Thomas, Lovely; Sharma, Roshni; Yadav, Bijesh; Jeyaseelan, Lakshmanan; Arul, Ashwin O.; Victor, Punitha; Chandiraseharan, Vignesh K.; Lenin, Audrin; Carey, Ronald AB.; Jayakaran, Jonathan AJ.; Krishnaswami, Rajiv K.; Peter, John Victor

Introduction The role of NIV in SARS-CoV2 (COVID-19) related acute respiratory failure (C-ARF) is unclear. Methods C-ARF patients managed on NIV were categorised as NIV success or failure (death or intubation). Factors associated with failure were explored using regression analysis and expressed as Odds ratio (OR) with 95% Confidence Interval (CI). Results Between 1st April 2020 and 15th September 2020, 286 patients, age (Mean, SD) 53.1±11.6 years and APACHE-II score 11.1±5.5 were initiated on NIV. Of the 182 patients (63.6%) successfully managed on NIV alone, 118 had moderate or severe Acute Respiratory Distress Syndrome (ARDS). When compared with NIV success, NIV failure was associated with lower admission PaO2/FiO2 ratio (p<0.001) and higher respiratory rate (p<0.001). On penalized logistic regression analysis, NIV failure was associated with higher APACHE (OR 1.12; 95%CI 1.01-1.24), severe ARDS (OR 3.99; 1.24-12.9), D-dimer ≥1000 ng/ml (OR 2.60; 1.16-5.87), need for inotropes or dialysis (OR 12.7; 4.3-37.7) and nosocomial infections (OR 13.6; 4.06-45.9). Overall mortality was 30.1%. In patients requiring intubation, time to intubation was longer in non-survivors than survivors (Median IQR 5 (3-8) vs. 3 (2-3) days, p<0.001). Conclusions NIV can be used successfully in C-ARF. Illness severity and need for non-respiratory organ support predict NIV failure.