Rationale: Treatment with non-invasive ventilation (NIV) in COVID-19 is frequent. Shortage of Intensive care unit (ICU) beds led clinicians to deliver NIV also outside intensive care units (ICUs). Data about the use of NIV in COVID-19 is limited. Objective: To describe the prevalence and clinical characteristics of patients with COVID-19 treated with NIV outside the ICUs. To investigate the factors associated with NIV failure (need for intubation or death). Methods: In this prospective single day observational study, we enrolled adult COVID-19 patients, treated with NIV outside the ICU from thirty-one hospitals in Lombardy, Italy. Results: We collected data on demographic, clinical characteristics, ventilatory management and patients' outcome. Of 8753 COVID-19 patients present in the hospitals on the study day, 909 (10%) were receiving NIV outside the ICU. 778/909 (85%) patients were treated with Continuous Positive Airway Pressure (CPAP), delivered by helmet in 617 (68%). NIV failed in 300 patients (37.6%), while 498 (62.4%) were discharged alive without intubation. Overall mortality was 25%. NIV failure occurred in 152/284 (53%) patients with a PaO2/FiO2 ratio < 150 mmHg. Higher C-reactive protein, lower PaO2/FiO2, and platelet counts were independently associated with increased risk of NIV failure. Conclusions: The use of NIV outside the ICUs, in COVID-19 was common, with a predominant use of helmet CPAP, with a rate of success greater than 60% and close to 75% in full treatment patients. C-reactive protein, PaO2/FiO2, platelet counts were independently associated with increased risk of NIV failure.

Noninvasive Ventilatory Support of COVID-19 Patients Outside the Intensive Care Units (WARd-COVID) / G. Bellani, G. Grasselli, M. Cecconi, L. Antolini, M. Borelli, F. De Giacomi, G. Bosio, N. Latronico, M. Filippini, M. Gemma, C. Giannotti, B. Antonini, N. Petrucci, S.M. Zerbi, P. Maniglia, G.P. Castelli, G. Marino, M. Subert, G. Citerio, D. Radrizzani, T.S. Mediani, F.L. Lorini, F.M. Russo, A. Faletti, A. Beindorf, R.D. Covello, S. Greco, M.M. Bizzarri, G. Ristagno, F. Mojoli, A. Pradella, P. Severgnini, M. Da Macallè, A. Albertin, V.M. Ranieri, E. Rezoagli, G. Vitale, A. Magliocca, G. Cappelleri, M. Docci, S. Aliberti, F. Serra, E. Rossi, M.G. Valsecchi, A. Pesenti, G. Foti. - In: ANNALS OF THE AMERICAN THORACIC SOCIETY. - ISSN 2325-6621. - (2021). [Epub ahead of print]

Noninvasive Ventilatory Support of COVID-19 Patients Outside the Intensive Care Units (WARd-COVID)

G. Grasselli;G. Ristagno;S. Aliberti;A. Pesenti;
2021

Abstract

Rationale: Treatment with non-invasive ventilation (NIV) in COVID-19 is frequent. Shortage of Intensive care unit (ICU) beds led clinicians to deliver NIV also outside intensive care units (ICUs). Data about the use of NIV in COVID-19 is limited. Objective: To describe the prevalence and clinical characteristics of patients with COVID-19 treated with NIV outside the ICUs. To investigate the factors associated with NIV failure (need for intubation or death). Methods: In this prospective single day observational study, we enrolled adult COVID-19 patients, treated with NIV outside the ICU from thirty-one hospitals in Lombardy, Italy. Results: We collected data on demographic, clinical characteristics, ventilatory management and patients' outcome. Of 8753 COVID-19 patients present in the hospitals on the study day, 909 (10%) were receiving NIV outside the ICU. 778/909 (85%) patients were treated with Continuous Positive Airway Pressure (CPAP), delivered by helmet in 617 (68%). NIV failed in 300 patients (37.6%), while 498 (62.4%) were discharged alive without intubation. Overall mortality was 25%. NIV failure occurred in 152/284 (53%) patients with a PaO2/FiO2 ratio < 150 mmHg. Higher C-reactive protein, lower PaO2/FiO2, and platelet counts were independently associated with increased risk of NIV failure. Conclusions: The use of NIV outside the ICUs, in COVID-19 was common, with a predominant use of helmet CPAP, with a rate of success greater than 60% and close to 75% in full treatment patients. C-reactive protein, PaO2/FiO2, platelet counts were independently associated with increased risk of NIV failure.
Settore MED/41 - Anestesiologia
Settore MED/10 - Malattie dell'Apparato Respiratorio
4-gen-2021
Article (author)
File in questo prodotto:
File Dimensione Formato  
517_bellani_Ann Am Thorac Soc. 2021_annalsats.202008-1080oc.pdf

accesso riservato

Tipologia: Post-print, accepted manuscript ecc. (versione accettata dall'editore)
Dimensione 470.89 kB
Formato Adobe PDF
470.89 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/809178
Citazioni
  • ???jsp.display-item.citation.pmc??? 39
  • Scopus 57
  • ???jsp.display-item.citation.isi??? 53
social impact