Clinical outcomes, safety, and potential prognostic factors of noninvasive respiratory support in patients with COVID-19: A Japanese multicenter observational study.

Publication date: Jun 30, 2025

This study aimed to explore the clinical practice of noninvasive respiratory support (NIRS) in COVID-19 patients, and assess its clinical outcomes, safety, and prognostic factors. A multicenter, retrospective observational study was conducted with consecutive adult COVID-19 patients who underwent NIRS at nine Japanese hospitals between January 1 and September 30, 2021. NIRS modalities included high-flow nasal cannula oxygen therapy (HFNC), noninvasive ventilation (NIV), and continuous positive airway pressure (CPAP). NIRS failure, defined as intubation or in-hospital death, intubation rate, in-hospital mortality, and the incidence of SARS-CoV-2 infection in health care workers (HCWs) were evaluated. The respiratory rate-oxygenation (ROX) index was examined as a predictor of NIRS failure. We included 694 patients with a median age of 61 years, of whom 516 (74. 4 %) were men. HFNC was the first-line respiratory support for 622 (89. 6 %) patients, followed by CPAP in 54 (7. 8 %) and NIV in 18 (2. 6 %). The NIRS failure rate was 41. 5 %, with an intubation rate of 32. 0 % and in-hospital mortality of 18. 4 %. The ROX index at baseline and 1 and 24 h after NIRS initiation were independent predictors of NIRS failure (odds ratio [95 % CI] 0. 89 [0. 85-0. 94], p

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