Noninvasive ventilatory support of patients with covid-19 outside the intensive care units (ward-covid)

COVID-19 Lombardy ICU Network, G. Bellani, G. Grasselli, M. Cecconi, L. Antolini, M. Borelli, F. De Giacomi, G. Bosio, N. Latronico, M. Filippini, M. Gemma, C. Giannotti, B. Antonini, N. Petrucci, S.M. Zerbi, P. Maniglia, G.P. Castelli, G. Marino, M. Subert, G. CiterioD. Radrizzani, T.S. Mediani, F.L. Lorini, F.M. Russo, A. Faletti, A. Beindorf, R.D. Covello, S. Greco, M.M. Bizzarri, G. Ristagno, F. Mojoli, A. Pradella, P. Severgnini, M. Da Macallè, A. Albertin, V.M. Ranieri, E. Rezoagli, G. Vitale, A. Magliocca, G. Cappelleri, M. Docci, S. Aliberti, F. Serra, E. Rossi, M.G. Valsecchi, A. Pesenti, G. Foti

Research output: Contribution to journalArticlepeer-review


Rationale: Treatment with noninvasive ventilation (NIV) in coronavirus disease (COVID-19) is frequent. Shortage of intensive care unit (ICU) beds led clinicians to deliver NIV also outside ICUs. Data about the use of NIV in COVID-19 is limited. Objectives: To describe the prevalence and clinical characteristics of patientswith COVID-19 treated with NIVoutside the ICUs. To investigate the factors associated with NIV failure (need for intubation or death). Methods: In this prospective, single-day observational study, we enrolled adult patients with COVID-19 who were treated with NIV outside the ICU from 31 hospitals in Lombardy, Italy. Results: We collected data on demographic and clinical characteristics, ventilatorymanagement, and patient outcomes.Of 8,753 patients with COVID-19 present in the hospitals on the study day, 909 (10%) were receiving NIV outside the ICU. A majority of patients (778/909; 85%) patients were treated with continuous positive airway pressure (CPAP), which was delivered by helmet in 617 (68%) patients. NIV failed in 300 patients (37.6%), whereas 498 (62.4%) patients were discharged alive without intubation. Overall mortality was 25%. NIV failure occurred in 152/284 (53%) patients with an arterial oxygen pressure (PaO2)/fraction of inspired oxygen (FIO2) ratio ,150 mm Hg. Higher C-reactive protein and lower PaO2/FIO2 and platelet counts were independently associated with increased risk of NIV failure. Conclusions: The use of NIV outside the ICUs was common in COVID-19, with a predominant use of helmet CPAP, with a rate of success.60% and close to 75% in full-treatment patients. C-reactive protein, PaO2/FIO2, and platelet counts were independently associated with increased risk of NIV failure.

Original languageEnglish
Pages (from-to)1020-1026
Number of pages7
JournalAnnals of the American Thoracic Society
Issue number6
Publication statusPublished - 2021


  • Coronavirus
  • COVID-19
  • Noninvasive ventilatory support
  • aged
  • cannula
  • endotracheal intubation
  • female
  • health care facility
  • hospital mortality
  • human
  • hypoxia
  • intensive care unit
  • Italy
  • male
  • middle aged
  • noninvasive ventilation
  • oxygen therapy
  • positive end expiratory pressure ventilation
  • procedures
  • prospective study
  • respiratory failure
  • treatment failure
  • Aged
  • Cannula
  • Continuous Positive Airway Pressure
  • Female
  • Hospital Mortality
  • Humans
  • Hypoxia
  • Intensive Care Units
  • Intubation, Intratracheal
  • Male
  • Middle Aged
  • Noninvasive Ventilation
  • Oxygen Inhalation Therapy
  • Patients' Rooms
  • Prospective Studies
  • Respiratory Insufficiency
  • SARS-CoV-2
  • Treatment Failure


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