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Abstract

BACKGROUND - The COVID-19 pandemic caused a major burden on the healthcare system. Since the beginning of the pandemic, the timing of intubation in patients with COVID-19 induced acute respiratory distress syndrome (ARDS) remained an area of debate. STUDY DESIGN AND METHODS - A single-center, retrospective cohort study of all adult patients (n=161) with COVID-19 admitted to the ICU with acute hypoxic respiratory failure were included. The group was divided into patients intubated after a trial of NIV (N=100) and patients intubated without a trial of NIV (N=61). The primary outcome was to compare the mortality rates between the two groups. RESULTS ICU mortality was higher in patients intubated after a trial of the NIV group compared to those without a trial of NIV (69 % vs 52%, p = 0.044). Patients initially treated with a trial of NIV had an odds ratio (OR) of 2.17 for mortality compared to those intubated without a trial of NIV (95% CI 1.04-4.54). ICU length of stay was higher in the intubation after a trial of the NIV group, 11.9 vs 7.7 days (p= 0.001). Patients intubated after a trial of NIV had a longer hospital Length of stay (LOS) (IRR 1.39, 95% CI 1.05- 1.85, p =0.022). However, the duration of mechanical ventilation was similar in the two groups. CONCLUSION In ARDS, a lung protective strategy with low TV has been proven to improve patient outcomes. The use of a trial of NIV prior to intubation is associated with an increase in mortality.

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