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Non-invasive ventilation for SARS-CoV-2 acute respiratory failure: a subanalysis from the HOPE COVID-19 registry
  1. Maurizio Bertaina1,2,
  2. Ivan J Nuñez-Gil3,
  3. Luca Franchin2,4,
  4. Inmaculada Fernández Rozas5,
  5. Ramón Arroyo-Espliguero6,
  6. María C Viana-Llamas6,
  7. Rodolfo Romero7,
  8. Charbel Maroun Eid8,
  9. Aitor Uribarri9,
  10. Víctor Manuel Becerra-Muñoz10,
  11. Jia Huang11,
  12. Emilio Alfonso12,
  13. Fernando Marmol-Mosquera13,
  14. Fabrizio Ugo14,
  15. Enrico Cerrato15,
  16. Lucia Fernandez-Presa16,
  17. Sergio Raposeiras Roubin17,
  18. Gisela Feltes Guzman18,
  19. Adelina Gonzalez19,
  20. Mohammad Abumayyaleh20,
  21. Antonio Fernandez-Ortiz3,
  22. Carlos Macaya3,
  23. Vicente Estrada3
  24. On behalf of HOPE COVID-19 investigators
  1. 1 Department of Cardiology, San Giovanni Bosco Hospital, Turin, Piemonte, Italy
  2. 2 Emergency Medicine Department, Martini Hospital Centre, Torino, Piemonte, Italy
  3. 3 Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Community of Madrid, Spain
  4. 4 Division of Cardiology, Cardiovascular and Thoracic Department, University Hospital Città della Salute e della Scienza, Turin, Italy
  5. 5 Cardiology Department, Severo Ochoa University Hospital, Leganes, Madrid, Spain
  6. 6 Department of Cardiology, General University Hospital of Guadalajara, Guadalajara, Castilla-La Mancha, Spain
  7. 7 Servicio de Urgencias, Getafe University Hospital, Getafe, Community of Madrid, Spain
  8. 8 Emergency Department, La Paz University Hospital, Madrid, Spain
  9. 9 Division of Cardiology, Valladolid University Clinical Hospital, Valladolid, Castilla y León, Spain
  10. 10 Division of Cardiology, Virgen de la Victoria University Hospital, Malaga, Andalucía, Spain
  11. 11 Department of Critical Care Medicine, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
  12. 12 Division of Cardiology, Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba
  13. 13 Internal Medicine Department, Hospital General del norte de Guayaquil IESS Los Ceibos, Guayaquil, Ecuador
  14. 14 Division of Cardiology, Sant'Andrea di Vercelli Hospital, Vercelli, Piedmont, Italy
  15. 15 Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Italy
  16. 16 Pulmonary Department, Hospital Clinico, Valencia, Spain
  17. 17 Division of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Galicia, Spain
  18. 18 Division of Cardiology, Hospital Nuestra Señora de América Madrid, Madrid, Spain
  19. 19 Infanta Sofia University Hospital, San Sebastian de los Reyes, Community of Madrid, Spain
  20. 20 University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
  1. Correspondence to Dr Maurizio Bertaina, Department of Cardiology, San Giovanni Bosco Hospital, Torino, Piemonte 10154, Italy; maurizio.bertaina{at}


Background The COVID-19 pandemic has seriously challenged worldwide healthcare systems and limited intensive care facilities, leading to physicians considering the use of non-invasive ventilation (NIV) for managing SARS-CoV-2-related acute respiratory failure (ARF).

Methods We conducted an interim analysis of the international, multicentre HOPE COVID-19 registry including patients admitted for a confirmed or highly suspected SARS-CoV-2 infection until 18 April 2020. Those treated with NIV were considered. The primary endpoint was a composite of death or need for intubation. The components of the composite endpoint were the secondary outcomes. Unadjusted and adjusted predictors of the primary endpoint within those initially treated with NIV were investigated.

Results 1933 patients who were included in the registry during the study period had data on oxygen support type. Among them, 390 patients (20%) were treated with NIV. Compared with those receiving other non-invasive oxygen strategy, patients receiving NIV showed significantly worse clinical and laboratory signs of ARF at presentation. Of the 390 patients treated with NIV, 173 patients (44.4%) met the composite endpoint. In-hospital death was the main determinant (147, 37.7%), while 62 patients (15.9%) needed invasive ventilation. Those requiring invasive ventilation had the lowest survival rate (41.9%). After adjustment, age (adjusted OR (adj(OR)) for 5-year increase: 1.37, 95% CI 1.15 to 1.63, p<0.001), hypertension (adj(OR) 2.95, 95% CI 1.14 to 7.61, p=0.03), room air O2 saturation <92% at presentation (adj(OR) 3.05, 95% CI 1.28 to 7.28, p=0.01), lymphocytopenia (adj(OR) 3.55, 95% CI 1.16 to 10.85, p=0.03) and in-hospital use of antibiotic therapy (adj(OR) 4.91, 95% CI 1.69 to 14.26, p=0.003) were independently associated with the composite endpoint.

Conclusion NIV was used in a significant proportion of patients within our cohort, and more than half of these patients survived without the need for intubation. NIV may represent a viable strategy particularly in case of overcrowded and limited intensive care resources, but prompt identification of failure is mandatory to avoid harm. Further studies are required to better clarify our hypothesis.

Trial registration numbers NCT04334291/EUPAS34399.

  • ventilation
  • non-invasive
  • acute care
  • respiratory
  • COVID-19

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Handling editor Lara Nicole Goldstein

  • Twitter @maurib89, @FernanMarmol

  • Contributors MB, IJN-G and LF initially planned the study, conducted and checked the statistical analysis on the dataset, and wrote the first draft of the paper. All the other authors were involved in the improvement of the study design and contributed significantly to the interpretation of data, revision of the paper’s drafts and approved the final version of the manuscript.

  • Funding The HOPE COVID-19 registry was supported by a not-conditioning promoter (Fundación interhospitalaria para la Investigación cardiovascular, FIC. Paseo del Pintor Rosales, Madrid, Spain; CIF: G-81563801).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.