Publication date: Jul 15, 2024

We assessed the effect of noninvasive ventilation (NIV) on mortality and length of stay after high flow nasal oxygenation (HFNO) failure among patients with severe hypoxemic COVID-19 pneumonia. In this multicenter, retrospective study, we enrolled COVID-19 patients admitted in intensive care unit (ICU) for severe COVID-19 pneumonia with a HFNO failure from December 2020 to January 2022. The primary outcome was to compare the 90-day mortality between patients who required a straight intubation after HFNO failure and patients who received NIV after HFNO failure. Secondary outcomes included ICU and hospital length of stay. A propensity score analysis was performed to control for confounding factors between groups. Exploratory outcomes included a subgroup analysis for 90-day mortality. We included 461 patients with HFNO failure in the analysis, 233 patients in the straight intubation group and 228 in the NIV group. The 90-day mortality did not significantly differ between groups, 58/228 (25. 4%) int the NIV group compared with 59/233 (25. 3%) in the straight intubation group, with an adjusted hazard ratio (HR) after propensity score weighting of 0. 82 [95%CI, 0. 50-1. 35] (p = 0. 434). ICU length of stay was significantly shorter in the NIV group compared to the straight intubation group, 10. 0 days [IQR, 7. 0-19. 8] versus 18. 0 days [IQR,11. 0-31. 0] with a propensity score weighted HR of 1. 77 [95%CI, 1. 29-2. 43] (p 

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