Noninvasive ventilation in COVID-19 patients aged ≥ 70 years—a prospective multicentre cohort study
Authors: Polok Kamil , Fronczek Jakub , Artigas Antonio , Flaatten Hans , Guidet Bertrand , De Lange Dylan W. , Fjølner Jesper , Leaver Susannah , Beil Michael , Sviri Sigal , Bruno Raphael Romano , Wernly Bernhard , Bollen Pinto Bernardo , Schefold Joerg C. , Studzińska Dorota , Joannidis Michael , Oeyen Sandra , Marsh Brian , Andersen Finn H. , Moreno Rui , Cecconi Maurizio , Jung Christian , Szczeklik Wojciech ,   COVIP Study Group, Eller Philipp , Joannidis Michael , Mesotten Dieter , Reper Pascal , Oeyen Sandra , Swinnen Walter , Brix Helene , Brushoej Jens , Villefrance Maja , Nedergaard Helene Korvenius , Bjerregaard Anders Thais , Balleby Ida Riise , Andersen Kasper , Hansen Maria Aagaard , Uhrenholt Stine , Bundgaard Helle , Fjølner Jesper , Hussein Aliae A. R. Mohamed , Salah Rehab , Ali Yasmin Khairy NasrEldin Mohamed , Wassim Kyrillos , Elgazzar Yumna A. , Tharwat Samar , Azzam Ahmed Y. , habib Ayman abdelmawgoad , Abosheaishaa Hazem Maarouf , Azab Mohammed A. , Leaver Susannah , Galbois Arnaud , Guidet Bertrand , Charron Cyril , Guerot Emmanuel , Besch Guillaume , Rigaud Jean-Philippe , Maizel Julien , Djibré Michel , Burtin Philippe , Garcon Pierre , Nseir Saad , Valette Xavier , Alexandru Nica , Marin Nathalie , Vaissiere Marie , Plantefeve Gaëtan , Vanderlinden Thierry , Jurcisin Igor , Megarbane Buno , Caillard Anais , Valent Arnaud , Garnier Marc , Besset Sebastien , Oziel Johanna , RAPHALEN Jean-herlé , Dauger Stéphane , Dumas Guillaume , Goncalves Bruno , Piton Gaël , Barth Eberhard , Goebel Ulrich , Barth Eberhard , Kunstein Anselm , Schuster Michael , Welte Martin , Lutz Matthias , Meybohm Patrick , Steiner Stephan , Poerner Tudor , Haake Hendrik , Schaller Stefan , Schaller Stefan , Schaller Stefan , Kindgen-Milles Detlef , Meyer Christian , Kurt Muhammed , Kuhn Karl Friedrich , Randerath Winfried , Wollborn Jakob , Dindane Zouhir , Kabitz Hans-Joachim , Voigt Ingo , Shala Gonxhe , Faltlhauser Andreas , Rovina Nikoletta , Aidoni Zoi , Chrisanthopoulou Evangelia , Papadogoulas Antonios , Gurjar Mohan , Mahmoodpoor Ata , Ahmed Abdullah khudhur , Marsh Brian , Elsaka Ahmed , Sviri Sigal , Comellini Vittoria , Rabha Ahmed , Ahmed Hazem , Namendys-Silva Silvio A. , Ghannam Abdelilah , Groenendijk Martijn , Zegers Marieke , de Lange Dylan , Cornet Alex , Evers Mirjam , Haas Lenneke , Dormans Tom , Dieperink Willem , Romundstad Luis , Sjøbø Britt , Andersen Finn H. , Strietzel Hans Frank , Olasveengen Theresa , Hahn Michael , Czuczwar Miroslaw , Gawda Ryszard , Klimkiewicz Jakub , de Lurdes Campos Santos Maria , Gordinho André , Santos Henrique , Assis Rui , Oliveira Ana Isabel Pinho , Badawy Mohamed Raafat , Perez-Torres David , Gomà Gemma , Villamayor Mercedes Ibarz , Mira Angela Prado , Cubero Patricia Jimeno , Rivera Susana Arias , Tomasa Teresa , Iglesias David , Vázquez Eric Mayor , Aldecoa Cesar , Ferreira Aida Fernández , Zalba-Etayo Begoña , Canas-Perez Isabel , Tamayo-Lomas Luis , Diaz-Rodriguez Cristina , Sancho Susana , Priego Jesús , Abualqumboz Enas M. Y. , Hilles Momin Majed Yousuf , Saleh Mahmoud , Ben-HAmouda Nawfel , Roberti Andrea , Dullenkopf Alexander , Fleury Yvan , Bollen Pinto Bernardo , Schefold Joerg C. , Al-Sadawi Mohammed 
Published: July 2022

Abstract
Background
Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV.

Methods
This is a substudy of COVIP study—an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality.

Results
Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36–5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06–2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI − 2.27 to − 0.46 days) compared to primary IMV group (n = 1876).

Conclusions
Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV.
Clinical Trial RegistrationNCT04321265, registered 19 March 2020, https://clinicaltrials.gov.