RT Journal Article SR Electronic T1 High Failure Rate of Noninvasive Oxygenation Strategies in Critically Ill Subjects With Acute Hypoxemic Respiratory Failure Due to COVID-19 JF Respiratory Care FD American Association for Respiratory Care SP 705 OP 714 DO 10.4187/respcare.08622 VO 66 IS 5 A1 Luca Salvatore Menga A1 Luca Delle Cese A1 Filippo Bongiovanni A1 Gianmarco Lombardi A1 Teresa Michi A1 Filippo Luciani A1 Marta Cicetti A1 Jacopo Timpano A1 Maria Cristina Ferrante A1 Melania Cesarano A1 Gian Marco Anzellotti A1 Tommaso Rosà A1 Daniele Natalini A1 Eloisa S Tanzarella A1 Salvatore Lucio Cutuli A1 Gabriele Pintaudi A1 Gennaro De Pascale A1 Antonio M Dell'Anna A1 Giuseppe Bello A1 Mariano Alberto Pennisi A1 Salvatore Maurizio Maggiore A1 Riccardo Maviglia A1 Domenico Luca Grieco A1 Massimo Antonelli YR 2021 UL http://rc.rcjournal.com/content/66/5/705.abstract AB BACKGROUND: 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.METHODS: 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, and 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.RESULTS: 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 (P = .009) and serum lactate dehydrogenase at enrollment (P = .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%, P = .02), with an adjusted hazard ratio of 2 (95% CI 1.1–3.6, P = .01).CONCLUSIONS: 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.