Noninvasive Ventilation Tied to Higher Mortality Than CPAP in COVID-19 Pneumonia
NEW YORK (Reuters Health) – Compared with continuous positive airway pressure (CPAP), use of non-invasive ventilation (NIV) to treat acute respiratory failure secondary to COVID-19 pneumonia is tied to higher mortality, according to a new review.
However, as Dr. Davide Alberto Chiumello of the University of Milan, Italy, and colleagues point out, “due to the heterogeneity of data reporting and patients’ baseline characteristics, it was difficult to assess if treatment with NIV was dedicated to patients with more severe disease.”
The researchers examined data from 23 studies published between December 2019 and November 2020. These included 4,776 patients and contained data on in-hospital mortality in COVID-19 patients treated with NIV or CPAP.
Hospital stay on average ranged from 6.2 to 21 days, and 1956 patients (40.9%) died in hospital, the team reports in the Journal of Critical Care.
Complications were under-reported, say the researchers, but mostly were unrelated to CPAP/NIV treatment. The most common complications, described in five reports, included pulmonary embolisms, renal failure, cerebrovascular accident, heart failure, septic shock, as well as ventilator-associated pneumonia.
Forty-six percent of the patients (2,192) received non-invasive respiratory support. Of these, 48.4% received CPAP, 46% had NIV, and 4% had either CPAP or NIV. This support failed in 47.7% of patients, of whom 582 (26.5%) were intubated.
Among reasons for intubation were decreased level of consciousness, refractory hypoxemia, sepsis and hemodynamic instability.
Twenty-nine percent of patients treated with CPAP or NIV died while on non-invasive respiratory support, including 22.2% of CPAP recipients, 35.1% of NIV recipients and 49% of CPAP/NIV recipients.
Of the 582 patients who were intubated after CAP/NIV failure, 59.8% died on invasive mechanical ventilation.
“Both CPAP and NIV have been demonstrated to reduce work of breathing, increase oxygenation and reduce intubation rates in patients with acute hypoxic respiratory failure,” the researchers say. “However, the indication for starting a non-invasive respiratory support in COVID-related acute respiratory distress syndrome is still debated.”
They conclude that both approaches “appear equally and frequently applied in patients with COVID-19 pneumonia, but associated with high mortality. Robust evidence is urgently needed to confirm the clinical efficacy of non-invasive respiratory support in COVID-19-related ARDS.”
Dr. Chiumello did not respond to requests for comments.
SOURCE: https://bit.ly/3zcprEr Journal of Critical Care, online May 21, 2021.
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