BACKGROUND

The COVID-19 pandemic caused a major burden on the healthcare system. Since the beginning of the pandemic, the timing of intubation in patients with COVID-19 induced acute respiratory distress syndrome (ARDS) remained an area of debate.

RESEARCH QUESTION

Does a trial of non-invasive ventilation (NIV) in COVID-19 patients worsen mortality in patients intubated due to ARDS?

STUDY DESIGN AND METHODS

A single-center, retrospective cohort study of all adult patients (n = 161) with COVID-19 admitted to the ICU between March 2020 through September 2022 with acute hypoxic respiratory failure were included. The group was divided into patients intubated after a trial of NIV (N = 100) and patients intubated without a trial of NIV (N = 61). The primary outcome was to compare the mortality rates between the two groups.

MEASUREMENTS AND MAIN RESULTS

ICU mortality (defined as death during ICU admission) was higher in patients intubated after a trial of the NIV group compared to those without a trial of NIV (69% vs 52%, p = 0.044). Patients initially treated with a trial of NIV had an odds ratio (OR) of 2.17 for mortality compared to those intubated without a trial of NIV (95% CI 1.04-4.54). ICU length of stay was higher in the intubation after a trial of the NIV group, 11.9 vs 7.7 days (p = 0.001). Patients intubated after a trial of NIV had a longer hospital Length of stay (LOS) (IRR 1.39, 95% CI 1.05-1.85, p = 0.022). However, the duration of mechanical ventilation was similar in the two groups (IRR 1.23, 95% CI 1.93-4.68, p = 0.35). The incidence of pneumothorax, ventilator associated pneumonia (VAP), and venous thromboembolism (VTE) were similar in the two groups.

CONCLUSION

In ARDS, a lung protective strategy with low TV has been proven to improve patient outcomes. The use of a trial of NIV prior to intubation is associated with an increase in mortality.