Clinical outcome of severe and critical covid patient receiving NIV or invasive ventilation

Oxygen support therapy plays a pivotal role in managing severe COVID-19 pneumonias causing respiratory failure. Non-invasive ventilation (NIV) strategies are commonly suggested methods to improve oxygenation in such patients.

We aimed to determine clinical outcomes in hypoxemic COVID-19 patients receiving non-invasive vs. invasive ventilation.

This cross-sectional study was conducted on 40 patients who tested positive by RT-PCR for SARS-CoV-2 RNA and required either invasive or NIV and admitted to the ICU of the 15th of May hospital for 3 months from June 2022 to August 2022. Patients were classified as: Severe: SpO2 < 90%, Pao2\FiO2 < 300, RR > 30, or lung infiltrate > 50%. Critical: the above criteria plus respiratory failure, septic shock, and\or multiorgan dysfunction.

There was a significant difference between the two groups regarding shifting to another mode and ferritin levels. In the NIV group, seven patients were successfully discharged and only two patients were discharged in the invasive group. There was a significant difference between critical and severe regarding length of stay (ICU and Hospital). The Kaplan-Meier survival curve for dead cases showed that the mortality occurrence was significant in invasive ventilation than NIV group with mean duration free from death in NIV group 18.8 compared to 14.8 in the invasive ventilation group.

The NIV use in subjects with critical-to-severe COVID-19 was successful in most of the subjects and can be a safe treatment option. Invasive mechanical ventilation is associated with adverse outcomes possibly due to ventilator-associated lung injury.