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New Emirates Medical Journal

Volume 3, 2 Issues, 2022
ISSN: 0250-6882 (Online)
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Open Access Article

The Use of Intermittent Non-Invasive Ventilation as an Alveolar Recruitment Method for Patient with Severe COVID-19 Pneumonia

Mazen Zouwayhed1, *, Saria Gouher2, Balu Bhaskar1, Moeena Zain2, Samer Burghleh2, Rania Khani3, Razan Yousef2, Abdul Rahman Khan2, Naim Aoun1
1 Department of Pulmonary/ Critical Care, American Hospital Dubai, Dubai, UAE
2 Department of Internal Medicine, American Hospital Dubai, Dubai, UAE
3 Department of Pharmacy, American Hospital Dubai, Dubai, UAE



The use of non-invasive ventilation (NIV) as a therapy for acute respiratory distress syndrome (ARDS) secondary to COVID-19 pneumonia has been controversial. NIV is an aerosol generating procedure which may increase the risk of viral transmission amongst patients and staff. Because of fear of aerosolizing the virus and transmitting the disease, initial expert recommendation was to avoid NIV and proceed with early intubation. With further experience of the virus, this recommendation has been challenged and NIV has been used widely with some retrospective studies quoting between 11 to 56 percent of COVID-19 related respiratory failures being treated with NIV.


The objective of this study is to assess the efficacy and safety of using non-invasive mechanical ventilation as an alveolar recruitment method for patients with severe COVID-19 pneumonia. This method was used by our respiratory team on selected patients during the early phase of the COVID-19 pandemic.


We reviewed the charts of patients that were admitted to the American Hospital Dubai intensive care unit, or our medical step-down unit who had diffuse bilateral infiltrates requiring oxygen supplementation between March and October 2020. We identified patients who were on intermittent BiPAP in addition to standard care. We also monitored the rate of infection among staff taking care of these patients.


Average length of stay after starting BIPAP therapy was 6.8 days, while the average total length of stay was 13.6 days. Only one patient was transferred to the ICU after being on the BIPAP protocol and did not need intubation. All patients were discharged home either without oxygen or with their chronic baseline home oxygen requirement. Radiological improvement in aeration was seen in 100% of patients at follow-up x-ray post-intervention. There were no reported pulmonary complications from barotrauma, such as pneumothorax or pneumomediastinum. There were no reported cases of staff infection to the health care workers that were taking care of these patients.


Our first of its kind observational study showed clearly that using BIPAP therapy for one hour three times daily during nebulization therapy in addition to standard care resulted in a significant reduction in hospital length of stay and hastened the clinical and radiological improvement of patients with severe COVID-19 pneumonia.

Keywords: COVID-19, BIPAP, Pneumonia, ARDS, Length of stay, Non-invasive mechanical ventilation COVID-19, Non-invasive ventilation.

Article Information

Identifiers and Pagination:

Year: 2022
Volume: 3
Issue: 1
First Page: 54
Last Page: 58
Publisher Id: nemj-3-54
DOI: 10.2174/03666211227175233

Article History:

Received Date: 07/6/2021
Revision Received Date: 15/8/2021
Acceptance Date: 10/11/2021
Electronic publication date: 21/01/2022
Collection year: 2022

© 2022 Zouwayhed et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Department of Pulmonary/ Critical Care, American Hospital Dubai, Dubai, UAE; Tel: 0545011075; E-mail:


Abdullah Shehab
Emirates Cardiac Society
Emirates Medical Association
(United Arab Emirates)
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Acceptance rate = 40%

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