Evaluation of complications and mortality in patients with Covid-19 treated with non-invasive ventilation in a 30-days follow-up

Abstract

When hypoxic respiratory failure occurs in patients with COVID-19 and ARDS, supportive oxygenation is the first line of treatment. For patients with decreased oxygen saturation who are still hypoxic despite receiving supportive oxygen with a mask, non-invasive ventilation is recommended. The current study aims to investigate the complications and mortality rate of patients with COVID-19 treated with non-invasive ventilation in a 30-day follow-up. Materials and Methods: In this cross-sectional study, patients with COVID-19 confirmed by a positive PCR test of nasopharyngeal samples who were hospitalized in Imam Reza and Sinai medical training centers and needed respiratory support enrolled. The sample size included 50 patients who underwent NIV. In these people after hospitalization, demographic information (including age, sex, underlying diseases); symptoms upon presentation (including headache, sore throat, dry cough, taste and smell disorders, myalgia, etc.); paraclinical findings (including white blood cell count, lymphocyte count, creatinine, alkaline phosphatase, liver function tests, LDH, CRP, and arterial blood gas analysis); and clinical examination (including respiratory rate, oxygen saturation level in room air and the percentage of lung involvement compatible with Covid-19 in lung CT scan) were recorded in the designed patient information collection forms. The 30-day follow-up of these patients is recorded daily in the designed forms. Complications (including pneumothorax, pneumomediastinum, and death) and mode of received oxygen support (including intubation and invasive and non-invasive ventilation) were recorded. Results: Among the 50 examined patients, 28 patients (56%) died during hospitalization. The results showed that the median age of dead patients is significantly higher than those discharged (p=0.018). Variables of age (OR=1.24; 95%CI [1.05-1.67]; p=0.001) and QSOFA (OR=1.48; 95%CI [0.98-2.33]; p=0.001) at the time of hospitalization of patients, were predictors of in-hospital mortality. Regarding complications, the incidence of pneumothorax was significantly higher in patients who died during hospitalization than in discharged patients (17.9% vs. 8.1%; p=0.001). Also, all the patients who died during hospitalization and after receiving NIV required intubation, and they died within a few hours to a few days after intubation.