Outcome of Non-Invasive vs. Invasive Ventilation in Critically Ill COVID-19 Patients at a Tertiary Care Center

Introduction: The COVID-19 pandemic presented significant challengesin managing acute respiratory failure (ARF) in critically ill patients, with noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) as keyinterventions. Due to high mortality rates with early intubation and limitedventilator resources, NIV use increased, although its effectiveness in COVID-19-related ARF remains uncertain. This study aimed to compare the outcomes ofNIV and IMV in critically ill COVID-19 patients and explore demographic andclinical factors influencing these outcomes. Methods: This retrospective, observational study, conducted at the NepalArmed Police Force (APF) Hospital, examined the outcomes of three patientgroups: NIV-only, NIV followed by IMV, and IV without prior NIV. Data werecollected from 238 COVID-19 ICU patients between April 2020 and July 2021.The primary outcome measure was mortality. Results: The results revealed that patients managed exclusively with NIV hada significantly lower mortality rate (16.2%) compared to those intubatedearly (74.7%) or after an NIV trial (73.2%). Logistic regression analysis identifiedsignificant predictors of mortality, including advanced age, use of inotropes,and lower PaO2/FiO2 ratios at admission. NIV-only treatment was associatedwith a reduced risk of mortality (odds ratio 0.068, p < 0.001). Conclusion: This study underscores the potential benefits of NIV as a first-lineintervention in critically ill COVID-19 patients and provides insights into optimalresource allocation in settings with limited medical equipment.