Noninvasive Ventilation in the Management of Respiratory Failure Due to COVID-19 Infection: Experience From a Resource-Limited Setting

Objective: To study the role of noninvasive ventilation (NIV) in Severe Acute Respiratory SyndromeCoronavirus 2 (SARS-CoV2) related acute respiratory failure (C-ARF). Patients and Methods: Patients with C-ARF managed on NIV were categorized as NIV success or failure (death or intubation). Factors associated with failure were explored using regression analysis and expressed as odds ratio (OR) with 95% CI. Results: Between April 1, 2020, and September 15, 2020, a total of 286 patients with a mean +/- SD age of 53.1 +/- 11.6 years and Acute Physiology and Chronic Health Evaluation II score of 11.1 +/- 5.5 were initiated on NIV. Of the 182 patients (63.6%) successfully managed on NIV alone, 118 had moderate or severe acute respiratory distress syndrome. When compared with NIV success, NIV failure was associated with lower admission PaO2 to fraction of inspired oxygen ratio (P<.001) and higher respiratory rate (P<.001). On penalized logistic regression analysis, NIV failure was associated with higher Acute Physiology and Chronic Health Evaluation II score (OR, 1.12; 95% CI, 1.01 to 1.24), severe acute respiratory distress syndrome (OR, 3.99; 95% CI, 1.24 to 12.9), D-dimer level of 1000 ng/mL DDU (to convert to mg/L, divide by 1000) or greater (OR, 2.60; 95% CI, 1.16 to 5.87), need for inotropes or dialysis (OR, 12.7; 95% CI, 4.3 to 37.7), and nosocomial infections (OR, 13.6; 95% CI, 4.06 to 45.9). Overall mortality was 30.1% (86/286). In patients requiring intubation, time to intubation was longer in nonsurvivors than survivors (median, 5; interquartile range, 3-8 vs 3; Conclusion: Noninvasive ventilation can be used successfully in C-ARF. Illness severity and need for (c) 2021 Mayo Foundation for Medical Education and Research center dot Mayo Clin Proc. 2022;97(1):31-45

Automated summary

The study investigated the role of noninvasive ventilation in SARS-CoV2 related acute respiratory failure, finding that NIV success rate was 63.6% and factors associated with failure included lower admission PaO2 to FiO2 ratio and higher respiratory rate.