Noninvasive respiratory support in octogenarian patients with COVID-19

Because of decline in lung function and higher rates of comorbidities, aging may contribute to progression to severe forms of COVID-19. As a result, fatality rates of patients aged 80years or older admitted to the intensive care unit (ICU) for COVID-19-associated acute respiratory distress syndrome (ARDS) may exceed 80%. In this scenario, the use of invasive mechanical ventilation (IMV) resulted in extremely poor clinical outcomes, and noninvasive respiratory support (NIRS), including high flow nasal oxygen (HFNO), continuous positive airway pressure (CPAP), and noninvasive positive pressure ventilation (NPPV), was considered a potentially effective option to provide ventilatory treatment outside the ICU. However, the efficacy of NIRS in ARF secondary to SARS-CoV-2 infection remains controversial and the noninvasive approach should be used with caution in very old patients. Switching from NIRS to IMV is debated, as older patients transitioning to IMV do not appear to benefit from escalation therapy.