Polok, KamilFronczek, JakubArtigas, AntonioFlaatten, HansGuidet, BertrandDe Lange, Dylan W.Fjølner, JesperLeaver, SusannahBeil, MichaelSviri, SigalBruno, Raphael RomanoWernly, BernhardBollen Pinto, BernardoSchefold, Joerg C.Studzińska, DorotaJoannidis, MichaelOeyen, SandraMarsh, BrianAndersen, Finn H.Moreno, RuiCecconi, MaurizioJung, ChristianSzczeklik, WojciechEller, PhilippMesotten, DieterReper, PascalSwinnen, WalterBrix, HeleneBrushoej, JensVillefrance, MajaNedergaard, Helene KorveniusBjerregaard, Anders ThaisBalleby, Ida RiiseAndersen, KasperHansen, Maria AagaardUhrenholt, StineBundgaard, HelleHussein, Aliae A.R.MohamedSalah, RehabAli, Yasmin Khairy Nasr Eldin MohamedWassim, KyrillosElgazzar, Yumna A.Tharwat, SamarAzzam, Ahmed Y.habib, Ayman abdelmawgoadAbosheaishaa, Hazem MaaroufAzab, Mohammed A.Galbois, ArnaudCharron, CyrilGuerot, Emmanuel2022-09-062022-09-062022-07-221364-8535PURE: 46124537PURE UUID: 8d3f9117-4134-4428-9949-9fb40b3758e7Scopus: 85135202514PubMed: 35869557WOS: 000829031000001http://hdl.handle.net/10362/143540Funding Information: COVIP study did not have any funding. Publication of this article was funded by the Priority Research Area qLife under the program “Excellence Initiative – Research University” at the Jagiellonian University in Krakow (06/IDUB/2019/94). Publisher Copyright: © 2022, The Author(s).Background: Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV. Methods: This is a substudy of COVIP study—an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality. Results: Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36–5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06–2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI − 2.27 to − 0.46 days) compared to primary IMV group (n = 1876). Conclusions: Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV. Clinical Trial RegistrationNCT04321265, registered 19 March 2020, https://clinicaltrials.gov.1036660engCOVID-19ElderlyFrailtyIntensive care unitNoninvasive ventilationCritical Care and Intensive Care Medicinejournal article10.1186/s13054-022-04082-1https://www.scopus.com/pages/publications/85135202514