Improved survival following ward-based non-invasive pressure support for severe hypoxia in a cohort of frail patients with COVID-19: retrospective analysis from a UK teaching hospital

BMJ Open Respir Res. 2020 Jul;7(1):e000621. doi: 10.1136/bmjresp-2020-000621.


Since the outbreak of COVID-19 in China in December 2019, a pandemic has rapidly developed on a scale that has overwhelmed health services in a number of countries. COVID-19 has the potential to lead to severe hypoxia; this is usually the cause of death if it occurs. In a substantial number of patients, adequate arterial oxygenation cannot be achieved with supplementary oxygen therapy alone. To date, there has been no clear guideline endorsement of ward-based non-invasive pressure support (NIPS) for severely hypoxic patients who are deemed unlikely to benefit from invasive ventilation. We established a ward-based NIPS service for COVID-19 PCR-positive patients, with severe hypoxia, and in whom escalation to critical care for invasive ventilation was not deemed appropriate. A retrospective analysis of survival in these patients was undertaken. Twenty-eight patients were included. Ward-based NIPS for severe hypoxia was associated with a 50% survival in this cohort. This compares favourably with Intensive Care National Audit and Research Centre survival data following invasive ventilation in a less frail, less comorbid and younger population. These results suggest that ward-based NIPS should be considered as a treatment option in an integrated escalation strategy in all units managing respiratory failure secondary to COVID-19.

Keywords: assisted ventilation; lung physiology; non invasive ventilation; respiratory infection; viral infection.

MeSH terms

  • Aged, 80 and over
  • Betacoronavirus / isolation & purification
  • COVID-19
  • Continuous Positive Airway Pressure / methods*
  • Coronavirus Infections* / epidemiology
  • Coronavirus Infections* / physiopathology
  • Coronavirus Infections* / therapy
  • Female
  • Frailty* / diagnosis
  • Frailty* / physiopathology
  • Frailty* / therapy
  • Geriatric Assessment / methods*
  • Humans
  • Lung / diagnostic imaging
  • Male
  • Outcome and Process Assessment, Health Care
  • Oximetry / methods
  • Oximetry / statistics & numerical data
  • Oxygen Consumption
  • Pandemics*
  • Pneumonia, Viral* / epidemiology
  • Pneumonia, Viral* / physiopathology
  • Pneumonia, Viral* / therapy
  • Respiratory Care Units* / methods
  • Respiratory Care Units* / organization & administration
  • Respiratory Insufficiency* / etiology
  • Respiratory Insufficiency* / mortality
  • Respiratory Insufficiency* / physiopathology
  • Respiratory Insufficiency* / therapy
  • SARS-CoV-2
  • Survival Analysis
  • Tomography, X-Ray Computed / methods
  • United Kingdom / epidemiology