• Luca Salvatore Menga, Luca Delle Cese, Filippo Bongiovanni, Gianmarco Lombardi, Teresa Michi, Filippo Luciani, Marta Cicetti, Jacopo Timpano, Maria Cristina Ferrante, Melania Cesarano, Gian Marco Anzellotti, Tommaso Rosà, Daniele Natalini, Eloisa S Tanzarella, Salvatore Lucio Cutuli, Gabriele Pintaudi, Gennaro De Pascale, Antonio M Dell'Anna, Giuseppe Bello, Mariano Alberto Pennisi, Salvatore Maurizio Maggiore, Riccardo Maviglia, Domenico Luca Grieco, and Massimo Antonelli.
• Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS; Rome, Italy.
• Respir Care. 2021 May 1; 66 (5): 705714705-714.

BackgroundThe efficacy of noninvasive oxygenation strategies (NIOS) in treating COVID-19 disease is unknown. We conducted a prospective observational study to assess the rate of NIOS failure in subjects treated in the ICU for hypoxemic respiratory failure due to COVID-19.MethodsPatients receiving first-line treatment NIOS for hypoxemic respiratory failure due to COVID-19 in the ICU of a university hospital were included in this study; laboratory data were collected upon arrival, and 28-d outcome was recorded. After propensity score matching based on Simplified Acute Physiology (SAPS) II score, age, [Formula: see text] and [Formula: see text] at arrival, the NIOS failure rate in subjects with COVID-19 was compared to a previously published cohort who received NIOS during hypoxemic respiratory failure due to other causes.ResultsA total of 85 subjects received first-line treatment with NIOS. The most frequently used methods were helmet noninvasive ventilation and high-flow nasal cannula; of these, 52 subjects (61%) required endotracheal intubation. Independent factors associated with NIOS failure were SAPS II score (P = .009) and serum lactate dehydrogenase at enrollment (P = .02); the combination of SAPS II score ≥ 33 with serum lactate dehydrogenase ≥ 405 units/L at ICU admission had 91% specificity in predicting the need for endotracheal intubation. In the propensity-matched cohorts (54 pairs), subjects with COVID-19 showed higher risk of NIOS failure than those with other causes of hypoxemic respiratory failure (59% vs 35%, P = .02), with an adjusted hazard ratio of 2 (95% CI 1.1-3.6, P = .01).ConclusionsAs compared to hypoxemic respiratory failure due to other etiologies, subjects with COVID-19 who were treated with NIOS in the ICU were burdened by a 2-fold higher risk of failure. Subjects with a SAPS II score ≥ 33 and serum lactate dehydrogenase ≥ 405 units/L represent the population with the greatest risk.Copyright © 2021 by Daedalus Enterprises.

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