Bilevel and continuous positive airway pressure and factors linked to all-cause mortality in COVID-19 patients in an intermediate respiratory intensive care unit in Italy

ABSTRACT

Objectives: In the present single-centered, retrospective, observational study, we reported findings from 78 consecutive laboratory-confirmed COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS) hospitalized in an intermediate Respiratory Intensive Care Unit, subdividing the patients into two groups according to their clinical outcome, dead patients and discharged patients.

Methods: We further subdivided patients depending on the noninvasive respiratory support used during hospitalization.

Results: In those patients who died, we found significant older age and higher multimorbidity and higher values of serum lactate dehydrogenase, C-reactive protein, and D-dimer. Among patients who were submitted to bilevel positive airway pressure (BPAP), those who died had a significant shorter number of days in overall length of stay and lower values of arterial oxygen partial pressure to fractional inspired oxygen ratio (PaO2/FiO2 ratio) compared to those who survived. No difference in all-cause mortality was observed between the two different noninvasive respiratory support groups [48% for continuous positive airway pressure (CPAP) and 52% for BPAP].

Conclusion: In COVID-19 patients with moderate-to-severe ARDS using BPAP in an intermediate level of hospital care had more factors associated to all-cause mortality (shorter length of stay and lower baseline PaO2/FiO2 ratio) compared to those who underwent CPAP.

KEYWORDS:

• Critical care
• respiratory infection
• viral infection
• assisted ventilation
• SARS-CoV-2
• intermediate RICU

Article highlights

• Findings from 78 consecutive laboratory-confirmed COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS) hospitalized in an intermediate Respiratory Intensive Care Unit (RICU) were reported subdividing the patients in two groups according to their clinical outcome, dead patients and discharged patients. We further subdivided patients depending on the non-invasive respiratory support used during hospitalization.

• In those patients who died, we found significantly older age and higher multimorbidity and higher values of serum lactate dehydrogenase, C-reactive protein, and D-dimer. However, in our study population, the median values of these laboratory parameters were not associated to a significant change of all-cause mortality rates because underpowered. Among patients who were submitted to bilevel positive airway pressure (BPAP), those who died had a shorter statistically significant number of days in overall length of stay as well as lower values of arterial oxygen partial pressure to fractional inspired oxygen ratio (PaO2/FiO2 ratio) compared to those who survived. No difference in all-cause mortality was observed between the two different noninvasive respiratory support groups [48% for to continuous positive airway pressure (CPAP) and 52% for BPAP].

• In an Italian intermediate RICU, despite having more factors associated to negative outcomes, COVID-19 patients with moderate-to-severe ARDS who underwent BIPAP had similar all-cause mortality compared to those who underwent CPAP. We need further evidence on larger samples to evaluate the correct non-invasive respiratory modality in COVID-19 patients to reduce short-term all-cause mortality.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Conceived and designed the study: GEC, VS, FP, and OR. Collected data: EB, GM, ER, VDL, and MLDC.

Analyzed the data: ER and VS. Wrote the manuscript: GEC, VS, FP, and OR.

Final supervision and guarantors of the paper: GM, SG, VP, FP, and OR.

Ethics statement

This study was compliant with Ethical Standards. Ethical approval and informed consent were obtained.

Additional information

Funding

This paper was not funded.