Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV. This is a substudy of COVIP study—an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality. Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36–5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06–2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI − 2.27 to − 0.46 days) compared to primary IMV group (n = 1876). Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV. Clinical Trial Registration NCT04321265 , registered 19 March 2020, https://clinicaltrials.gov .

中文翻译：

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≥ 70 岁 COVID-19 患者的无创通气——一项前瞻性多中心队列研究

无创通气 (NIV) 是一种有前途的有创机械通气 (IMV) 替代方法，在 COVID-19 大流行期间重症监护病房 (ICU) 床位短缺的情况下尤为重要。我们旨在评估 NIV 在欧洲的使用情况以及与接受 NIV 治疗的患者结局相关的因素。这是 COVIP 研究的一项子研究，COVIP 研究是一项国际前瞻性观察性研究，纳入了在 ICU 接受治疗且确诊为 COVID-19 且年龄≥70 岁的患者。2020 年 3 月至 2021 年 4 月期间，我们在 15 个欧洲国家的 156 个 ICU 招募了患者。主要终点是 30 天死亡率。队列包括 3074 名患者，其中大部分为男性 (2197/3074, 71.4%)，平均年龄为 75.7 岁 (SD 4.6)。NIV 频率为 25.7%，在参与国家之间从 1.1% 到 62.0% 不等。原发性 NIV 失败，定义为需要气管插管或在入住 ICU 后 30 天内死亡，发生在 470/629 (74.7%) 的患者中。与 NIV 失败风险增加相关的因素是更高的序贯器官衰竭评估 (SOFA) 评分（OR 3.73，95% CI 2.36-5.90）和入院时临床虚弱量表（CFS）（OR 1.46，95% CI 1.06-2.00）。与主要 IMV 组 (n = 1876) 相比，最初接受 NIV 治疗的患者 (n = 630) 少活了 1.36 天（95% CI − 2.27 至 − 0.46 天）。NIV 的使用频率因欧洲国家而异。在患有 COVID-19 的危重老年人中，更高的疾病严重程度和更严重的虚弱与 NIV 失败的风险相关。主要 IMV 比主要 NIV 具有更好的结果。临床试验注册 NCT04321265，2020 年 3 月 19 日注册，https://clinicaltrials.gov。