Clinical outcomes in patients with severe respiratory failure due to novel coronavirus disease 2019 treated with non-invasive respiratory support: observational, prospective study

Abstract

BACKGROUND: In the present study we aimed to analyze the response to non-invasive respiratory support in patients stratified with acute respiratory failure due to novel coronavirus disease. METHODS: A prospective, observational study was carried out in Hospital Universitario Rey Juan Carlos from February 1st to June 30th, 2020. The study was approved by the Ethics Committee of the Fundacion Jimenez Diaz. We included patients over 18 years of age with confirmed SARS-CoV-2 infection who required non-invasive respiratory support (N.=130). We classified patients included in the sample according to the three clinical scenarios established by the Spanish Respiratory Society. RESULTS: The mean age of the patients was 64.3 +/- 12.9 years;43.8% were older than 70, and the majority were male (N.=88;67.7%). Eighty percent of the study population (N.=104) presented comorbidities. The most used device was the continuous positive airway pressure (54.6%, N.=71). Non-invasive respiratory support-based treatment avoided Intensive Care Unit admission in 68% of the acute respiratory failure cases studied. Treatment-failure occurred in 43.8% of patients (37% clinical scenario 1, de-novo acute respiratory failure, P=0.04) and the overall rate of mortality was 36.2% (14.8% clinical scenario 1, P<0.00001). CONCLUSIONS: The used of non-invasive respiratory support was safe and clinically effective treatment (68% of ICU admissions prevented, lower rate of TF than that reported for other viral pneumonias, and a mortality rate of 14.8% within clinical scenario 1). Non-invasive respiratory support may be considered a first-line therapy for patients with severe COVID-19.