Noninvasive ventilation for acute hypoxemic respiratory failure in patients with COVID-19

Am J Emerg Med. 2021 Jan;39:154-157. doi: 10.1016/j.ajem.2020.09.075. Epub 2020 Oct 1.


Aim: Noninvasive ventilation (NIV) is known to reduce intubation in patients with acute hypoxemic respiratory failure (AHRF). We aimed to assess the outcomes of NIV application in COVID-19 patients with AHRF.

Materials & methods: In this retrospective cohort study, patients with confirmed diagnosis of COVID-19 and AHRF receiving NIV in general wards were recruited from two university-affiliated hospitals. Demographic, clinical, and laboratory data were recorded at admission. The failure of NIV was defined as intubation or death during the hospital stay.

Results: Between April 8 and June 10, 2020, 61 patients were enrolled into the final cohort. NIV was successful in 44 out of 61 patients (72.1%), 17 patients who failed NIV therapy were intubated, and among them 15 died. Overall mortality rate was 24.6%. Patients who failed NIV were older, and had higher respiratory rate, PaCO2, D-dimer levels before NIV and higher minute ventilation and ventilatory ratio on the 1-st day of NIV. No healthcare workers were infected with SARS-CoV-2 during the study period.

Conclusions: NIV is feasible in patients with COVID-19 and AHRF outside the intensive care unit, and it can be considered as a valuable option for the management of AHRF in these patients.

Keywords: Acute respiratory failure; COVID-19; Noninvasive ventilation.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • COVID-19 / complications*
  • COVID-19 / mortality
  • Female
  • Humans
  • Hypoxia / etiology
  • Intubation, Intratracheal / statistics & numerical data
  • Length of Stay
  • Male
  • Middle Aged
  • Noninvasive Ventilation / methods*
  • Respiratory Insufficiency / mortality
  • Respiratory Insufficiency / therapy*
  • Respiratory Insufficiency / virology
  • Respiratory Rate
  • Retrospective Studies
  • Russia / epidemiology