{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:32:26Z","timestamp":1760236346079,"version":"build-2065373602"},"reference-count":39,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2021,11,22]],"date-time":"2021-11-22T00:00:00Z","timestamp":1637539200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The best noninvasive respiratory strategy in patients with Coronavirus Disease 2019 (COVID-19) pneumonia is still discussed. We aimed at assessing the rate of endotracheal intubation (ETI) in patients treated with continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) if CPAP failed. Secondary outcomes were in-hospital mortality and in-hospital length of stay (LOS). A retrospective, observational, multicenter study was conducted in intermediate-high dependency respiratory units of two Italian university hospitals. Consecutive patients with COVID-19 treated with CPAP were enrolled. Thoraco-abdominal asynchrony or hemodynamic instability led to ETI. Patients showing SpO2 \u2264 94%, respiratory rate \u2265 30 bpm or accessory muscle activation on CPAP received NIV. Respiratory distress and desaturation despite NIV eventually led to ETI. 156 patients were included. The overall rate of ETI was 30%, mortality 18% and median LOS 24 (17\u201332) days. Among patients that failed CPAP (n = 63), 28% were intubated, while the remaining 72% received NIV, of which 65% were intubated. Patients intubated after CPAP showed lower baseline PaO2\/FiO2, lower lymphocyte counts and higher D-dimer values compared with patients intubated after CPAP + NIV. Mortality was 22% with CPAP + ETI, and 20% with CPAP + NIV + ETI. In the case of CPAP failure, a NIV trial appears feasible, does not deteriorate respiratory status and may reduce the need for ETI in COVID-19 patients.<\/jats:p>","DOI":"10.3390\/jcm10225444","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T23:22:28Z","timestamp":1638314548000},"page":"5444","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Feasibility and Clinical Outcomes of a Step Up Noninvasive Respiratory Support Strategy in Patients with Severe COVID-19 Pneumonia"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9290-5090","authenticated-orcid":false,"given":"Silvia","family":"Coppola","sequence":"first","affiliation":[{"name":"Department of Anesthesia and Intensive Care, San Paolo Hospital, ASST Santi Paolo e Carlo, Via di Rudini 8, 20142 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3462-8253","authenticated-orcid":false,"given":"Pierachille","family":"Santus","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Clinical Sciences (DIBIC), Universit\u00e0 degli Studi di Milano, Via G.B. Grassi 74, 20157 Milano, Italy"},{"name":"Division of Respiratory Diseases, L. Sacco University Hospital, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1600-4474","authenticated-orcid":false,"given":"Giovanni","family":"Sotgiu","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, Universit\u00e0 degli Studi di Sassari, Viale San Pietro, 07100 Sassari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9672-3534","authenticated-orcid":false,"given":"Michele","family":"Mondoni","sequence":"additional","affiliation":[{"name":"Respiratory Unit, San Paolo Hospital, ASST Santi Paolo e Carlo, Via di Rudin\u00ec 8, 20142 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessia","family":"Gandola","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, San Paolo Hospital, ASST Santi Paolo e Carlo, Via di Rudini 8, 20142 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Saad","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Clinical Sciences (DIBIC), Universit\u00e0 degli Studi di Milano, Via G.B. Grassi 74, 20157 Milano, Italy"},{"name":"Division of Respiratory Diseases, L. Sacco University Hospital, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe Francesco","family":"Sferrazza Papa","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Universit\u00e0 degli Studi di Milano, Via di Rudin\u00ec 8, 20142 Milano, Italy"},{"name":"Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Via Giuseppe Dezza 48, 20144 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Centanni","sequence":"additional","affiliation":[{"name":"Respiratory Unit, San Paolo Hospital, ASST Santi Paolo e Carlo, Via di Rudin\u00ec 8, 20142 Milano, Italy"},{"name":"Department of Health Sciences, Universit\u00e0 degli Studi di Milano, Via di Rudin\u00ec 8, 20142 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5131-9367","authenticated-orcid":false,"given":"Laura","family":"Saderi","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, Universit\u00e0 degli Studi di Sassari, Viale San Pietro, 07100 Sassari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davide Alberto","family":"Chiumello","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, San Paolo Hospital, ASST Santi Paolo e Carlo, Via di Rudini 8, 20142 Milano, Italy"},{"name":"Department of Health Sciences, Universit\u00e0 degli Studi di Milano, Via di Rudin\u00ec 8, 20142 Milano, Italy"},{"name":"Coordinated Research Center on Respiratory Failure, Universit\u00e0 degli Studi di Milano, Via di Rudini 8, 20142 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9013-3418","authenticated-orcid":false,"given":"Dejan","family":"Radovanovic","sequence":"additional","affiliation":[{"name":"Division of Respiratory Diseases, L. Sacco University Hospital, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, 20157 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1001\/jama.2020.1585","article-title":"Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China","volume":"323","author":"Wang","year":"2020","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1001\/jamainternmed.2020.3539","article-title":"Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy","volume":"180","author":"Grasselli","year":"2020","journal-title":"JAMA Intern. 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