Outcomes of COVID-19 patients treated with noninvasive respiratory support outside-ICU setting: a Portuguese reality (original) (raw)

Noninvasive respiratory support (NRS) has become a valuable tool in COVID-19 acute respiratory failure (ARF) management. However, there is a lack of consensus in for or against its use due to the risks of intubation delay and aerosols environmental contamination. 1 Strategies to mitigate NRS iatrogenic risks and healthcare workers infection have been suggested. 2,3 Despite efforts to increase ICU resources, to cope with patient influx, general wards worldwide were converted in respiratory intermediate care units (RICU), where patients in need for NRS were treated. 4,5 Our goal was to evaluate the Portuguese reality regarding safeness and outcomes of NRS in COVID-19 ARF in a non-ICU setting. Adult patients with COVID-19 pneumonia needing NRS [high flow nasal cannula (HFNC), continuous positive airway pressure (CPAP) and/or noninvasive ventilation (NIV)], treated in a RICU, were prospectively enrolled from November 18th, 2020 to February 18th, 2021. Institutional review boards authorised the study (n. 22/2021). Informed consent was waived. High flow nasal cannula was instituted if arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) 200 mmHg with FiO2 > 0.4, respiratory rate (RR) 25cpm and/or sings of respiratory distress. Continuous positive airway pressure and NIV was started if SpO2 <92%, RR 25bpm and/or sings of respiratory distress in patients with HFNC failure or ad initium if HFNC failure was expected. Arterial oxygen partial pressure to fractional inspired oxygen ratio was accessed before NRS institution. In patients with HFNC failure who increased support to CPAP/NIV, the PaO2/FiO2 considered was the one before CPAP/NIV. Noninvasive respiratory support settings were adjusted to maintain SpO2 92À96%. Continuous positive airway pressure and NIV was delivered by oronasal mask. All patients had a "do intubate" (DI)o r"do not intubate" (DNI) order defined at admission. Baseline patient's characteristics were compared according to NRS technique (HFNC vs. CPAP/NIV). The success rate was defined by invasive mechanical ventilation (IMV)-free survival. Several outcomes were recorded: length of stay, complications, need for endotracheal intubation (ETI) and