Management of patients with severe acute respiratory failure due to SARSCoV-2 pneumonia with non-invasive ventilatory support outside Intensive Care Unit.

Diaz de Teran, Teresa; Gonzales Martinez, Monica; Banfi, Paolo; Garuti, Giancarlo; Ferraioli, Gianluca; Russo, Giuseppe; Casu, Francesco; Vivarelli, Michela; Bonfiglio, Monica; Perazzo, Alessandro; Barlascini, Cornelius; Bauleo, Armando; Nicolini, Antonello; Solidoro, Paolo

BACKGROUND COVID-19 has high mortality rate mainly stemming from acute respiratory distress leading to respiratory failure (ARF ). Aim of the study is evaluating the management of severe ARF due to COVID-19 pneumonia using non-invasive ventilatory support (NIVS), studing safety and effectiveness of non-invasive ventilatory support (NIVS). METHODS This is a retrospective, multicenter study. Primary outcomes were NIVS failure with intubation rate and hospital mortality . Secondary outcomes were: hospital stay and factors related to NIVS failure and mortality. These outcomes were compared with patients intubated and admitted to ICU. RESULTS 162 patients were hospitalized because of severe respiratory failure ( PaO2/FiO2 ratio < 250 ). 138 patients were admitted to Respiratory Intermediate Care Unit (RICU) for a NIVS trial. One hundred patients were treated successfully with NIVS (74.5%); 38 failed NIVS trial (27.5%). In-hospital mortality was 23.18% in RICU group and 30.55% in ICU group. Patients with NIVS failure were older, had a lower number of lymphocytes, a higher IL-6 , lower PaO2, PaCO2, PaO2/FiO2 ratio, higher respiratory rate (RR) and heart rate at admission and lower PaO2 and PaO2/FiO2 ratio and higher RR after 1-6 hours . Multivariate analysis identified higher age, C-reactive protein as well as RR after 1-6 hours and PaO2/FiO2 ratio after 1-6 hours as an independent predictor mortality. CONCLUSIONS NIVS is a safe and effective strategy in the treatment of severe ARF due to COVID 19 related pneumonia, that reduces mortality and length of hospital stay in the carefully selected patient.