Skip to main content

Authors` response to “Efficacy of noninvasive ventilation in patients with COVID-19”

The Original Article was published on 29 November 2022

The Original Article was published on 22 July 2022

We thank Shen and colleagues for their interest in our paper on the use of noninvasive ventilation in older adults with COVID-19 [1].

We believe that the relatively high NIV failure rate in our study is multifactorial. First, participants in our study were significantly older than the sample enrolled by Arabi and colleagues (76 vs 58 years) in a study cited by the authors [2]. Despite not having collected granular data on pre-ICU respiratory support, we agree that many patients with severe COVID-19-related respiratory failure received high-flow nasal oxygen therapy or NIV outside of ICUs, potentially leading to a delay of intubation and worse outcomes.

We remain cautious about judging the appropriateness of NIV administration in the setting of an extraordinary disruption of standard treatment pathways during the studied period. Due to a shortage of ICU beds, the propensity to limit life-sustaining (LST) treatment was likely higher than before the pandemic [3, 4]. Nevertheless, we are confident that some patients in the primary NIV group would have been intubated in normal circumstances.

Comparison between the primary NIV and primary IMV group suggested a higher 30-day mortality rate in the former group. This observation was confirmed in a sensitivity analysis excluding patients in whom LST was limited when primary respiratory support modality was used. Conversely, another sensitivity analysis excluding all patients with LST limitation showed no difference between the groups. It might suggest that this difference is driven by high mortality in patients primarily treated with NIV who were subsequently intubated. This is in-line with our analysis showing an association between pre-intubation NIV duration and 30-day mortality. Nevertheless, we agree that further studies are needed to establish optimal respiratory support modes in different patient populations of critically ill patients.

Availability of data and materials

Not applicable.


  1. Polok K, Fronczek J, Artigas A, Flaatten H, Guidet B, De Lange DW, et al. Noninvasive ventilation in COVID-19 patients aged ≥ 70 years-a prospective multicentre cohort study. Crit Care. 2022;26(1):224.

    Article  Google Scholar 

  2. Arabi YM, Aldekhyl S, Al Qahtani S, Al-Dorzi HM, Abdukahil SA, Al Harbi MK, et al. Effect of helmet noninvasive ventilation vs usual respiratory support on mortality among patients with acute hypoxemic respiratory failure due to COVID-19: the HELMET-COVID randomized clinical trial. JAMA. 2022;328(11):1063–72.

    Article  CAS  Google Scholar 

  3. Guidet B, Jung C, Flaatten H, Fjølner J, Artigas A, Pinto BB, et al. Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19. Intensive Care Med. 2022;48(4):435–47.

    Article  CAS  Google Scholar 

  4. Van HPV, Beil M, Guidet B, Sviri S, Jung C, De LD, et al. A new multi-national network studying very old intensive care patients. Anaesiol Intensive Ther. 2021;53(4):1–6.

    Google Scholar 

Download references



Author information

Authors and Affiliations



KP, JF and WS prepared draft of the manuscript, revised it critically and approved the final version of the manuscript.

Corresponding author

Correspondence to Wojciech Szczeklik.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Competing interests


Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Polok, K., Fronczek, J. & Szczeklik, W. Authors` response to “Efficacy of noninvasive ventilation in patients with COVID-19”. Crit Care 26, 399 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: