Giacomo Bellani1,2, Giacomo Grasselli3,4, Maurizio Cecconi5,6, Laura Antolini1, Massimo Borelli7, Federica De Giacomi8, Giancarlo Bosio8, Nicola Latronico9,10, Matteo Filippini10, Marco Gemma11, Claudia Giannotti12, Benvenuto Antonini13, Nicola Petrucci14, Simone Maria Zerbi15, Paolo Maniglia16, Gian Paolo Castelli17, Giovanni Marino18, Matteo Subert19, Giuseppe Citerio1,2,20, Danilo Radrizzani21, Teresa S Mediani22, Ferdinando Luca Lorini23, Filippo Maria Russo23, Angela Faletti24, Andrea Beindorf25, Remo Daniel Covello26, Stefano Greco27, Marta M Bizzarri28, Giuseppe Ristagno3, Francesco Mojoli29, Andrea Pradella5, Paolo Severgnini30, Marta Da Macallè30, Andrea Albertin31, V Marco Ranieri32, Emanuele Rezoagli1,2,33, Giovanni Vitale33, Aurora Magliocca1,33, Gianluca Cappelleri34, Mattia Docci1,35, Stefano Aliberti4,36, Filippo Serra1, Emanuela Rossi1, Maria Grazia Valsecchi1, Antonio Pesenti3,4, Giuseppe Foti1,2. 1. Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. 2. Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital, and. 3. Department of Anesthesia, Intensive Care and Emergency, Foundation Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 4. Department of Pathophysiology and Transplantation, and. 5. Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center Istituto di Ricovero e Cura a Carattere Scientifico Milan, Italy. 6. Department of Biomedical Sciences, Humanitas University, Milan, Italy. 7. Department of Anesthesia and Intensive Care Medicine, Treviglio Caravaggio Hospital, Azienda Socio-Sanitaria Territoriale Bergamo Ovest, Treviglio, Italy. 8. Division of Pulmonary Medicine, Cremona Hospital, ASST Cremona, Cremona, Italy. 9. Department of Anesthesiology, Intensive Care and Emergency, Spedali Civili University Hospital, Azienda Socio-Sanitaria Territoriale Spedali Civili, Brescia, Italy. 10. Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy. 11. Department of Anesthesia and Intensive Care Unit, Fatebenefratelli Hospital, Azienda Socio-Sanitaria Territoriale Fatebenefratelli Sacco, Milan, Italy. 12. Department of Anesthesiology and Intensive Care, Luigi Sacco Hospital, Azienda Socio-Sanitaria Territoriale Fatebenefratelli Sacco, Polo Universitario, University of Milan, Milan, Italy. 13. Department of Anesthesiology and Intensive Care Medicine, Manerbio Hospital, and. 14. Department of Anesthesia and Intensive Care Unit, Desenzano Hospital, Azienda Socio-Sanitaria Territoriale Garda, Brescia, Italy. 15. Anesthesia and Intensive Care Unit 2, Sant'Anna Hospital, Azienda Socio-Sanitaria Territoriale Lariana, San Fermo della Battaglia, Como, Italy. 16. Department of Anesthesia and Intensive Care Medicine, Alessandro Manzoni Hospital, Azienda Socio-Sanitaria Territoriale Lecco, Lecco, Italy. 17. Department of Anesthesia and Intensive Care Medicine, Carlo Poma Hospital, Azienda Socio-Sanitaria Territoriale Mantova, Mantova, Italy. 18. Department of Anesthesia and Intensive Care Medicine, Vizzolo Predabissi Hospital, and. 19. Department of Anesthesia and Intensive Care Medicine, Melzo-Gorgonzola Hospital, Azienda Socio-Sanitaria Territoriale Melegnano e della Martesana, Melegnano, Milan, Italy. 20. Department of Anesthesia and Intensive Care Medicine, Desio Hospital, Azienda Socio-Sanitaria Territoriale Monza, Monza e Brianza, Italy. 21. Department of Anesthesia and Intensive Care Medicine, Legnano Hospital, Azienda Socio-Sanitaria Territoriale Ovest milanese, Legnano, Milano, Italy. 22. Department of Anesthesia and Intensive Care Medicine, Vigevano Hospital, Azienda Socio-Sanitaria Territoriale Pavia, Vigevano, Pavia, Italy. 23. Department of Anesthesia and Intensive Care, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy. 24. Department of Anesthesia and Intensive Care Medicine, Gardone Val Trompia Hospital, and. 25. Department of Anesthesia and Intensive Care Medicine, Montichiari Hospital, Azienda Socio-Sanitaria Territoriale Spedali Civili, Brescia, Italy. 26. Department of Anesthesia and Intensive Care Medicine, Busto Arsizio Hospital, and. 27. Department of Anesthesia and Intensive Care Medicine, Saronno Hospital, Azienda Socio-Sanitaria Territoriale Valle Olona, Varese, Italy. 28. Department of Anesthesia and Intensive Care Medicine, Vimercate Hospital, Azienda Socio-Sanitaria Territoriale Vimercate, Monza e Brianza, Italy. 29. Department of Anesthesia and Intensive Care Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo and University of Pavia, Pavia, Italy. 30. Biotechnology and Life Sciences Department, Insubria University-Anesthesia and Intensive Care Circolo and Fondazione Macchi Hospital, Azienda Socio-Sanitaria Territoriale Sette Laghi, Varese, Italy. 31. Department of Anesthesia and Intensive Care Medicine, San Giuseppe Hospital, Milan, Italy. 32. Department of Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy. 33. Policlinico San Marco, San Donato Group Hospitals, Zingonia, Bergamo, Italy. 34. Humanitas Gavazzeni, Bergamo, Italy. 35. Policlinico San Pietro, Ponte San Pietro, Italy; and. 36. Foundation Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.
Abstract
Rationale: Treatment with noninvasive ventilation (NIV) in coronavirus disease (COVID-19) is frequent. Shortage of intensive care unit (ICU) beds led clinicians to deliver NIV also outside ICUs. Data about the use of NIV in COVID-19 is limited. Objectives: 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 patients with COVID-19 who were treated with NIV outside the ICU from 31 hospitals in Lombardy, Italy. Results: We collected data on demographic and clinical characteristics, ventilatory management, and patient outcomes. Of 8,753 patients with COVID-19 present in the hospitals on the study day, 909 (10%) were receiving NIV outside the ICU. A majority of patients (778/909; 85%) patients were treated with continuous positive airway pressure (CPAP), which was delivered by helmet in 617 (68%) patients. NIV failed in 300 patients (37.6%), whereas 498 (62.4%) patients were discharged alive without intubation. Overall mortality was 25%. NIV failure occurred in 152/284 (53%) patients with an arterial oxygen pressure (PaO2)/fraction of inspired oxygen (FiO2) ratio <150 mm Hg. Higher C-reactive protein and lower PaO2/FiO2 and platelet counts were independently associated with increased risk of NIV failure.Conclusions: The use of NIV outside the ICUs was common in COVID-19, with a predominant use of helmet CPAP, with a rate of success >60% and close to 75% in full-treatment patients. C-reactive protein, PaO2/FiO2, and platelet counts were independently associated with increased risk of NIV failure.Clinical trial registered with ClinicalTrials.gov (NCT04382235).
Rationale: Treatment with noninvasive ventilation (NIV) in coronavirus disease (COVID-19) is frequent. Shortage of intensive care unit (ICU) beds led clinicians to deliver NIV also outside ICUs. Data about the use of NIV in COVID-19 is limited. Objectives: 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 patients with COVID-19 who were treated with NIV outside the ICU from 31 hospitals in Lombardy, Italy. Results: We collected data on demographic and clinical characteristics, ventilatory management, and patient outcomes. Of 8,753 patients with COVID-19 present in the hospitals on the study day, 909 (10%) were receiving NIV outside the ICU. A majority of patients (778/909; 85%) patients were treated with continuous positive airway pressure (CPAP), which was delivered by helmet in 617 (68%) patients. NIV failed in 300 patients (37.6%), whereas 498 (62.4%) patients were discharged alive without intubation. Overall mortality was 25%. NIV failure occurred in 152/284 (53%) patients with an arterial oxygen pressure (PaO2)/fraction of inspired oxygen (FiO2) ratio <150 mm Hg. Higher C-reactive protein and lower PaO2/FiO2 and platelet counts were independently associated with increased risk of NIV failure.Conclusions: The use of NIV outside the ICUs was common in COVID-19, with a predominant use of helmet CPAP, with a rate of success >60% and close to 75% in full-treatment patients. C-reactive protein, PaO2/FiO2, and platelet counts were independently associated with increased risk of NIV failure.Clinical trial registered with ClinicalTrials.gov (NCT04382235).
Entities:
Keywords:
COVID-19; coronavirus; noninvasive ventilatory support
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