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Predictor factors for non-invasive mechanical ventilation failure in severe COVID-19 patients in the intensive care
Antonio Romanelli1, Pietro Toigo2, Giuliana Scarpati2,3
1Department of Anaesthesia and Intensive Care, AOU "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy. antonioromanelli86@gmail.com.
Background:
During the COVID-19 pandemia, non-invasive mechanical ventilation (NIV) has been largely applied. Few data are available about predictors of NIV failure in critical COVID-19 patients admitted to ICU. The aim of this study is to analyze clinical and laboratory features able to predict non-invasive ventilation success in avoiding endotracheal intubation.
Methods:
A retrospective observational study was performed in our COVID-19 ICU during a 6-month period. Demographic, clinical, laboratory, imaging, and outcome data were extracted from electronic and paper medical records and anonymously collected.
Results:
Eighty-two severe COVID-19 patients were supported by NIV at ICU admission. The median PaO2/FiO2 ratio was 125 [98.5-177.7]. NIV failed in 44 cases (53%). Patients who experienced NIV failure had a higher Charlson Comorbidity Index (median value 4) compared to those who were dismissed without endotracheal intubation (median 2, p < 0.0001). At Cox regression analysis, the Charlson Comorbidity Index represented a predictive factor related to NIV failure. PaO2/FiO2, CPK, INR, and AT III at ICU admission showed a significant relationship with the outcome, when single variables were adjusted for the Charlson Comorbidity Index.
Conclusion:
The Charlson Comorbidity Index may be helpful to stratify patients' risk of NIV failure in a severe COVID-19 population; even if this study, retrospective design does not allow definitive conclusions.
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