Outcomes of COVID-19 patients intubated after failure of non-invasive ventilation: a multicenter observational study
Authors: Boscolo Annalisa , Pasin Laura , Sella Nicolò , Pretto Chiara , Tocco Martina , Tamburini Enrico , Rosi Paolo , Polati Enrico , Donadello Katia , Gottin Leonardo , Vianello Andrea , Landoni Giovanni , Navalesi Paolo ,   FERS, for the COVID-19 VENETO ICU Network, Valeri Ilaria , Andreatta Giulio , Gandolfi Leonardo , Gadaldi Alessandra , Brumana Nicolò , Forin Edoardo , Correale Christelle , Fregolent Davide , Pirelli Pier Francesco , Marchesin Davide , Perona Matteo , Franchetti Nicola , Paolera Michele Della , Simoni Caterina , Falcioni Tatiana , Tresin Alessandra , Schiavolin Chiara , Schiavi Aldo , Vathi Sonila , Sartori Daria , Sorgato Alice , Pistollato Elisa , Linassi Federico , Golino Gian Lorenzo , Frigo Laura , Serra Eugenio , Pittarello Demetrio , Tiberio Ivo , Bond Ottavia , Michieletto Elisa , Muraro Luisa , Peralta Arianna , Persona Paolo , Petranzan Enrico , Zarantonello Francesco , Pettenuzzo Tommaso , Graziano Alessandro , De Cassai Alessandro , Bernardi Lorenzo , Pianon Roberto , Badii Flavio , Bosco Enrico , Agostini Moreno , Trevisiol Paride , Farnia Antonio , Peta Mario , Altafini Lorella , Calò Mauro Antonio , Meggiolaro Marco , Lazzari Francesco , Martinello Ivan , Fullin Giorgio , Papaccio Francesco , Toffoletto Fabio , Bonato Alfeo , Sgarabotto Camilla , Baratto Fabio , Montacciani Francesco , Parnigotto Alessandra , Gagliardi Giuseppe , Gioconda Ferraro , Ongaro Luigi , Baiocchi Marco , Danzi Vinicio , De Rosa Silvia , Polati Enrico , Donadello Katia , Gottin Leonardo , Zanatta Paolo , Sinigaglia Ezio , da Ros Alessandra , Marchiotto Simonetta , Bassanini Silvia , Zamperini Massimo , Daroui Ivan , Mosaner Walter , Lembo Rosalba 
Published: September 2021

The efficacy of non-invasive ventilation (NIV) in acute respiratory failure secondary to SARS-CoV-2 infection remains controversial. Current literature mainly examined efficacy, safety and potential predictors of NIV failure provided out of the intensive care unit (ICU). On the contrary, the outcomes of ICU patients, intubated after NIV failure, remain to be explored. The aims of the present study are: (1) investigating in-hospital mortality in coronavirus disease 2019 (COVID-19) ICU patients receiving endotracheal intubation after NIV failure and (2) assessing whether the length of NIV application affects patient survival. This observational multicenter study included all consecutive COVID-19 adult patients, admitted into the twenty-five ICUs of the COVID-19 VENETO ICU network (February–April 2020), who underwent endotracheal intubation after NIV failure. Among the 704 patients admitted to ICU during the study period, 280 (40%) presented the inclusion criteria and were enrolled. The median age was 69 [60–76] years; 219 patients (78%) were male. In-hospital mortality was 43%. Only the length of NIV application before ICU admission (OR 2.03 (95% CI 1.06–4.98), p = 0.03) and age (OR 1.18 (95% CI 1.04–1.33), p < 0.01) were identified as independent risk factors of in-hospital mortality; whilst the length of NIV after ICU admission did not affect patient outcome. In-hospital mortality of ICU patients intubated after NIV failure was 43%. Days on NIV before ICU admission and age were assessed to be potential risk factors of greater in-hospital mortality.