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 Menga, Luca Salvatore
A1 Cese, Luca Delle
A1 Bongiovanni, Filippo
A1 Lombardi, Gianmarco
A1 Michi, Teresa
A1 Luciani, Filippo
A1 Cicetti, Marta
A1 Timpano, Jacopo
A1 Ferrante, Maria Cristina
A1 Cesarano, Melania
A1 Anzellotti, Gian Marco
A1 Rosà, Tommaso
A1 Natalini, Daniele
A1 Tanzarella, Eloisa S
A1 Cutuli, Salvatore Lucio
A1 Pintaudi, Gabriele
A1 De Pascale, Gennaro
A1 Dell'Anna, Antonio M
A1 Bello, Giuseppe
A1 Pennisi, Mariano Alberto
A1 Maggiore, Salvatore Maurizio
A1 Maviglia, Riccardo
A1 Grieco, Domenico Luca
A1 Antonelli, Massimo
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.