LAUSR

INTRODUCTION: Intensivists have faced difficult decisions about when to intubate patients during the Covid 19 pandemic. Initial studies had suggested that early intubation may be beneficial, as patients would avoid self induced lung injury, whereas later studies indicated that delaying intubation could be advantageous in some patients by avoiding the inherent risks of mechanical ventilation. This study aims to assess if NIPPV and HiFlow NC are safe methods of oxygenation in patients with Covid 19 ARDS and can prevent intubation. METHOD(S): A retrospective chart review of 693 patients was conducted. These patients tested positive for Covid 19 during hospitalization AND required supplemental oxygen via either HiFlow or NIPPV (including CPAP and BiPAP). Demographic and clinical characteristics were compared between intubated and nonintubated patients. Associations between days on NIPPV/HiFlow and hospital outcomes were assessed by univariable linear regression for continuous outcomes and by univariable logistic regression for dichotomous outcomes. Subgroup analysis was conducted on patients who were intubated, those who were in the ICU, and those who died. All analyses were conducted using R v. 4.0.3. RESULT(S): Among all patients, each additional day on NIPPV/HiFlow was associated with a 0.14 day decrease in overall hospital length of stay and reduced odds of intubation. Furthermore, each additional day on NIPPV/HiFlow was NOT associated with increased odds of complications such as VTE, PE, cerebral thrombosis, pneumothorax, GI bleeding or ICU admission. This held true in the subgroups as well. We also found that when compared against nonintubated patients, intubated patients had a significantly shorter median length of time on NIPPV/HiFlow (5 days vs 7) and a longer total median hospital length of stay (23 days vs 11), along with a significantly higher rate of VTE (15% vs 4.9%), pneumothorax (8.1% vs 1.5%), cerebral thrombosis (4.5% vs 1.5%), and PE (4.5% vs 1.1%). CONCLUSION(S): Our results suggest that NIPPV/ HiFlow does not worsen patient outcomes in patients with Covid 19 and may save some patients from intubation. Nonetheless, intubation should not be withheld in patients who decompensate on NIPPV/HiFlow as these patients have more Covid related complications and require additional support.