Noninvasive Respiratory Support Outside of ICU Feasible for COVID-19

Patients hospitalized with coronavirus disease 2019 (COVID-19) who were treated with noninvasive respiratory support outside of the intensive care unit (ICU) had favorable outcomes, but a risk of staff contamination persisted, according to study results published in The European Respiratory Journal.

Medication, mode, and usage of noninvasive respiratory support were evaluated from hospitalized patients with COVID-19 treated outside of the ICU. The primary study outcomes were the length of stay in hospital, rate of endotracheal intubation, deaths, and staff infection rates.

Of the 670 consecutive patients with confirmed COVID-19 referred to pulmonology units in 9 hospitals, 69.3% were men and the mean age was 68 years. Nearly half of the patients (49.3%) were treated with continuous positive airway pressure. The overall 30-day mortality rate was 26.9%, with specific rates of 16%, 30%, and 30%, for high-flow nasal cannula, continuous positive airway pressure, and noninvasive ventilation, respectively. The rates of endotracheal intubation and the length of stay in hospital were not different among the groups.

A total of 11.4% of healthcare workers tested positive for infection. Only 3 individuals required hospitalization.  

“[T]his is the first observational, large multicenter study showing that the application of noninvasive respiratory devices outside the ICU is feasible but is associated with a risk of staff contamination,” the study authors wrote. “[H]owever, the retrospective study design precludes drawing firm conclusions about its effectiveness despite the fact that the mortality and intubation rates compare favorably with those of previous reports.”

Reference

Franco C, Facciolongo N, Tonelli R, et al. Feasibility and clinical impact of out-of-ICU non-invasive respiratory support in patients with COVID-19 related pneumonia. Eur Respir J. Published online August 3, 2020.  doi:10.1183/13993003.02130-2020