Noninvasive ventilation in COVID-19 patients aged ≥ 70 years-a prospective multicentre cohort study

Crit Care. 2022 Jul 22;26(1):224. doi: 10.1186/s13054-022-04082-1.


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 Registration NCT04321265 , registered 19 March 2020, .

Keywords: COVID-19; Elderly; Frailty; Intensive care unit; Noninvasive ventilation.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • COVID-19* / therapy
  • Cohort Studies
  • Female
  • Frailty*
  • Humans
  • Intensive Care Units
  • Male
  • Noninvasive Ventilation* / adverse effects
  • Pandemics
  • Prospective Studies
  • Respiration, Artificial
  • Respiratory Insufficiency* / therapy

Associated data