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Outcomes of COVID-19 Patients with Severe Hypoxemic Acute Respiratory Failure: Non-Invasive Ventilation vs. Straight Intubation—A Propensity Score-Matched Multicenter Cohort Study

The best timing for endotracheal intubation in patients with coronavirus disease 2019 (COVID-19) hypoxemic acute respiratory failure (hARF) remains debated. Aim of this study is to compare the outcomes of COVID-19 patients with hARF receiving either a trial of non-invasive ventilation (NIV) or intub...

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Detalles Bibliográficos
Autores principales: Pasin, Laura, Gregori, Dario, Pettenuzzo, Tommaso, De Cassai, Alessandro, Boscolo, Annalisa, Sella, Nicolò, Lorenzoni, Giulia, Geraldini, Federico, Pistollato, Elisa, Ranieri, Vito Marco, Landoni, Giovanni, Rosi, Paolo, Navalesi, Paolo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9605173/
https://www.ncbi.nlm.nih.gov/pubmed/36294387
http://dx.doi.org/10.3390/jcm11206063
Descripción
Sumario:The best timing for endotracheal intubation in patients with coronavirus disease 2019 (COVID-19) hypoxemic acute respiratory failure (hARF) remains debated. Aim of this study is to compare the outcomes of COVID-19 patients with hARF receiving either a trial of non-invasive ventilation (NIV) or intubated with no prior attempt of NIV (“straight intubation”). All consecutive patients admitted to the 25 participating ICUs were included and divided in two groups: the “straight intubation” group and the “NIV” group. A propensity score matching was performed to correct for biases associated with the choice of the respiratory support. Primary outcome was in-hospital mortality. Secondary outcomes were length of mechanical ventilation, hospital stay and reintubation rate. A total of 704 COVID-19 patients were admitted to ICUs during the study period. After matching, 141 patients were included in each group. No clinically relevant difference at ICU admission was found between groups. In-hospital mortality was significantly lower in the NIV group (22.0% vs. 36.2%), with no significant difference in secondary endpoints. There was no significant mortality difference between patients who received straight intubation and those intubated after NIV failure. In COVID-19 patients with hARF it is worth and safe attempting a trial of NIV prior to intubation.