Factors Associated with Non-invasive Positive Pressure Ventilation Failure in a COVID-19 Intermediate Care Unit

Overview

Journal Int J Emerg Med

Publisher Biomed Central

Specialty Emergency Medicine

Date 2023 May 12

PMID 37173632

Authors

Ines Farinha

Alexandra Tenda da Cunha

Ana Rita Nogueira

Andre Ribeiro

Carlos Silva

Joao Rua

Joao Trepa

Jose Eduardo Mateus

Filipa Costa

Affiliations

Soon will be listed here.

Abstract

Background: The use of non-invasive positive pressure ventilation (NIPPV) in COVID-19 patients with hypoxaemia is still under debate. The aim was to evaluate the efficacy of NIPPV (CPAP, HELMET-CPAP or NIV) in COVID-19 patients treated in the dedicated COVID-19 Intermediate Care Unit of Coimbra Hospital and University Centre, Portugal, and to assess factors associated with NIPPV failure.

Methods: Patients admitted from December 1st 2020 to February 28th 2021, treated with NIPPV due to COVID-19 were included. Failure was defined as orotracheal intubation (OTI) or death during hospital stay. Factors associated with NIPPV failure were included in a univariate binary logistic regression analysis; those with a significance level of p < 0.001 entered a multivariate logistic regression model.

Results: A total of 163 patients were included, 64.4% were males (n = 105). The median age was 66 years (IQR 56-75). NIPPV failure was observed in 66 (40.5%) patients, 26 (39.4%) were intubated and 40 (60.6%) died during their hospital stay. The highest CRP (OR 1.164; 95%CI 1.036-1.308) and morphine use (OR 24.771; 95%CI 1.809-339.241) were identified as predictors of failure after applying multivariate logistic regression. Adherence to prone positioning (OR 0.109; 95%CI 0.017-0.700) and a higher value of the lowest platelet count during hospital stay (OR 0.977; 95%CI 0.960-0.994) were associated with a favorable outcome.

Conclusions: NIPPV was successful in over half of patients. Highest CRP during hospital stay and morphine use were predictors of failure. Adherence to prone positioning and a higher value of the lowest platelet count during hospital stay were associated with a favourable outcome.

References

Gattinoni L, Meissner K, Marini J . The baby lung and the COVID-19 era. Intensive Care Med. 2020; 46(7):1438-1440. PMC: 7246291. DOI: 10.1007/s00134-020-06103-5. View

Nasa P, Azoulay E, Khanna A, Jain R, Gupta S, Javeri Y . Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method. Crit Care. 2021; 25(1):106. PMC: 7962430. DOI: 10.1186/s13054-021-03491-y. View

Wang X, Zhou Q, He Y, Liu L, Ma X, Wei X . Nosocomial outbreak of COVID-19 pneumonia in Wuhan, China. Eur Respir J. 2020; 55(6). PMC: 7236818. DOI: 10.1183/13993003.00544-2020. View

Islam K, Iqbal J . An Update on Molecular Diagnostics for COVID-19. Front Cell Infect Microbiol. 2020; 10:560616. PMC: 7683783. DOI: 10.3389/fcimb.2020.560616. View

Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L . COVID-19 pneumonia: different respiratory treatments for different phenotypes?. Intensive Care Med. 2020; 46(6):1099-1102. PMC: 7154064. DOI: 10.1007/s00134-020-06033-2. View

Renda T, Scala R, Corrado A, Ambrosino N, Vaghi A . Adult Pulmonary Intensive and Intermediate Care Units: The Italian Thoracic Society (ITS-AIPO) Position Paper. Respiration. 2021; 100(10):1027-1037. DOI: 10.1159/000516332. View

Rochwerg B, Einav S, Chaudhuri D, Mancebo J, Mauri T, Helviz Y . The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline. Intensive Care Med. 2020; 46(12):2226-2237. PMC: 7670292. DOI: 10.1007/s00134-020-06312-y. View

Alhazzani W, Moller M, Arabi Y, Loeb M, Gong M, Fan E . Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Crit Care Med. 2020; 48(6):e440-e469. PMC: 7176264. DOI: 10.1097/CCM.0000000000004363. View

Franco C, Facciolongo N, Tonelli R, Dongilli R, Vianello A, Pisani L . Feasibility and clinical impact of out-of-ICU noninvasive respiratory support in patients with COVID-19-related pneumonia. Eur Respir J. 2020; 56(5). PMC: 7397952. DOI: 10.1183/13993003.02130-2020. View

10.

Wu Z, McGoogan J . Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13):1239-1242. DOI: 10.1001/jama.2020.2648. View

11.

Gattinoni L, Coppola S, Cressoni M, Busana M, Rossi S, Chiumello D . COVID-19 Does Not Lead to a "Typical" Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2020; 201(10):1299-1300. PMC: 7233352. DOI: 10.1164/rccm.202003-0817LE. View

12.

Vitacca M, Nava S, Santus P, Harari S . Early consensus management for non-ICU acute respiratory failure SARS-CoV-2 emergency in Italy: from ward to trenches. Eur Respir J. 2020; 55(5). PMC: 7144262. DOI: 10.1183/13993003.00632-2020. View

13.

Grasselli G, Pesenti A, Cecconi M . Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response. JAMA. 2020; 323(16):1545-1546. DOI: 10.1001/jama.2020.4031. View