COVID-19 mortality high after noninvasive ventilation failure

Patients with the coronavirus disease 2019 (COVID-19) who had failed noninvasive ventilation (NIV) suffer from high rates of in-hospital mortality, a recent study has found.

The researchers conducted an observational, multicentre study including 280 adult COVID-19 patients (median age 69 years, 78 percent men) admitted to intensive care units (ICU) and who had undergone endotracheal intubation after NIV failure. Outcomes included in-hospital mortality and its predictors.

A total of 120 patients died during hospital stay, yielding a mortality rate of 43 percent. These patients had significantly more comorbidities (p<0.01) and weaker gas exchange before intubation. Sequential Organ Failure Assessment scores at ICU admission were likewise higher in those who died.

Moreover, patients older than 73 years of age showed a significantly higher mortality rate than their younger counterparts (62 percent vs 32 percent; p<0.01). The same was true for those who had received NIV >2 vs ≤2 days (63 percent vs 41 percent; p<0.01).

Stepwise multivariable regression analysis confirmed that increasing age (odds ratio [OR], 1.18, 95 percent confidence interval [CI], 1.04–1.33; p<0.01) and prolonged NIV use before ICU admission (OR, 2.30, 95 percent CI, 1.06–4.98; p=0.03) were significant risk factors for mortality.

“To the best of our knowledge, this is the first study focusing on the outcome of COVID-19 ICU patients intubated after NIV failure. Noteworthy, patients intubated after NIV failure showed a mortality rate no different from 292 patients receiving intubation without a previous NIV trial, which suggests that attempting NIV did not worsen outcome even in case of intubation after failure,” the researchers said.