Non-Invasive Ventilation an Alternative to Invasive Ventilation in Covid-19 Patients

Abstract

Objectives: To study the role of non-invasive ventilation (NIV) in the treatment of COVID-19 patients with mild to moderate acute respiratory distress syndrome (ARDS). Material and methods: Patients with positive RT-PCR for SARS-CoV-2 who required intensive care unit (ICU) admission due to COVID-19 related pneumonia with mild to moderate ARDS were included in the study. ARDS was treated with NIV, or mechanical ventilation (MV) if NIV failed. NIV was considered for patients admitted to the ICU with mild to moderate ARDS. Primary outcomes were NIV success and failure, defined by intubation and mechanical ventilation, and mortality. Secondary outcomes were determined by the duration of NIV and the number of days stayed in ICU. Results: NIV was successful in 37 patients (50%), whereas 37 patients required endotracheal intubation and invasive mechanical ventilation (50%). In the study, 15 (40.5%) of the 37 failed NIV patients who required intubation were successfully extubated and discharged from the ICU, whereas 22 (59.5%) died. Disease progression to severe ARDS, infection, and agitation were the leading causes of NIV failure, accounting for 60% of the cases related to severe ARDS. The number of comorbidities and complications caused by the illness itself had a high association with the death rate. Conclusion: This study revealed that noninvasive ventilation can be used as an alternative to mechanical ventilation as respiratory support for mild to moderate ARDS in COVID-19 patients. However, future multi-centric studies with a larger sample are required for more reliable evaluation. Keywords: Noninvasive Ventilation, Respiratory Distress Syndrome, COVID-19, Aerosols, Pneumonia, Intensive Care Units.