High Failure Rate of Noninvasive Oxygenation Strategies in Critically Ill Subjects With Acute Hypoxemic Respiratory Failure Due to COVID-19

• Published in: Respiratory care Vol. 66; no. 5; p. 705
• Main Authors: Menga, Luca Salvatore, Cese, Luca Delle, Bongiovanni, Filippo, Lombardi, Gianmarco, Michi, Teresa, Luciani, Filippo, Cicetti, Marta, Timpano, Jacopo, Ferrante, Maria Cristina, Cesarano, Melania, Anzellotti, Gian Marco, Rosà, Tommaso, Natalini, Daniele, Tanzarella, Eloisa S, Cutuli, Salvatore Lucio, Pintaudi, Gabriele, De Pascale, Gennaro, Dell'Anna, Antonio M, Bello, Giuseppe, Pennisi, Mariano Alberto, Maggiore, Salvatore Maurizio, Maviglia, Riccardo, Grieco, Domenico Luca, Antonelli, Massimo
• Format: Journal Article
• Language: English
• Published: United States 01.05.2021
• Subjects: COVID-19; Critical Illness; Humans; Hypoxia - etiology; Hypoxia - therapy; Noninvasive Ventilation; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; SARS-CoV-2; COVID-19; respiratory failure; positive-pressure ventilation; noninvasive ventilation
• ISSN: 1943-3654
• DOI: 10.4187/respcare.08622

The efficacy of noninvasive oxygenation strategies (NIOS) in treating COVID-19 disease is unknown. We conducted a prospective observational study to assess the rate of NIOS failure in subjects treated in the ICU for hypoxemic respiratory failure due to COVID-19. Patients receiving first-line treatment NIOS for hypoxemic respiratory failure due to COVID-19 in the ICU of a university hospital were included in this study; laboratory data were collected upon arrival, and 28-d outcome was recorded. After propensity score matching based on Simplified Acute Physiology (SAPS) II score, age, [Formula: see text] and [Formula: see text] at arrival, the NIOS failure rate in subjects with COVID-19 was compared to a previously published cohort who received NIOS during hypoxemic respiratory failure due to other causes. A total of 85 subjects received first-line treatment with NIOS. The most frequently used methods were helmet noninvasive ventilation and high-flow nasal cannula; of these, 52 subjects (61%) required endotracheal intubation. Independent factors associated with NIOS failure were SAPS II score ( = .009) and serum lactate dehydrogenase at enrollment ( = .02); the combination of SAPS II score ≥ 33 with serum lactate dehydrogenase ≥ 405 units/L at ICU admission had 91% specificity in predicting the need for endotracheal intubation. In the propensity-matched cohorts (54 pairs), subjects with COVID-19 showed higher risk of NIOS failure than those with other causes of hypoxemic respiratory failure (59% vs 35%, = .02), with an adjusted hazard ratio of 2 (95% CI 1.1-3.6, = .01). As compared to hypoxemic respiratory failure due to other etiologies, subjects with COVID-19 who were treated with NIOS in the ICU were burdened by a 2-fold higher risk of failure. Subjects with a SAPS II score ≥ 33 and serum lactate dehydrogenase ≥ 405 units/L represent the population with the greatest risk.