ABSTRACT

Objective:  To compare the patient outcome in severe COVID-19 pneumonia between the non-invasive ventilation and invasive mechanical ventilation.

Study design: Prospective, observational study
Study Setting and Duration: Department of Pulmonology, Bahawal Victoria Hospital, Bahawalpur from January 2021 to June 2021.
Methodology: We analyzed 660 patients of severe covid pneumonia. Conscious proning was done in those requiring ≥ 21 L oxygen and oxygen saturation < 90%. We defined typical ARDS according to Berlin criteria. Atypical ARDS did not fulfill set criteria. We divided ARDS into 2 types i-e H and L type. We managed ARDS with either NIV, invasive mechanical ventilation or both. We used multiple regression analysis to predict ICU stay.   
Results: Out of 660 patients, 285 (43.18%) developed biPAP failure and were subsequently intubated. We observed 273 (41.4%) overall mortality, 175 (64.1%) in IMV and 98 (35.9%) in the NIV group (p<0.0001). invasive mechanical ventilation had statistically significant correlation with mortality and also predicted ICU stay. (p=< 0.001, OR 3.2, p=0.001). 
Conclusion: NIV therapy is superior to invasive mechanical ventilation in terms of ICU stay and outcome.
Keywords: ARDS, coronavirus, COVID-19, non-invasive ventilation, mechanical ventilation, pneumonia