Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort.
Details
Serval ID
serval:BIB_378ACCE747B3
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort.
Journal
Critical care
Working group(s)
RISC-19-ICU Investigators
Contributor(s)
Wendel Garcia P.D., Aguirre-Bermeo H., Buehler P.K., Alfaro-Farias M., Yuen B., David S., Tschoellitsch T., Wengenmayer T., Korsos A., Fogagnolo A., Kleger G.R., Wu M.A., Colombo R., Turrini F., Potalivo A., Rezoagli E., Rodríguez-García R., Castro P., Lander-Azcona A., Martín-Delgado M.C., Lozano-Gómez H., Ensner R., Michot M.P., Gehring N., Schott P., Siegemund M., Merki L., Wiegand J., Jeitziner M.M., Laube M., Salomon P., Hillgaertner F., Dullenkopf A., Ksouri H., Cereghetti S., Grazioli S., Bürkle C., Marrel J., Fleisch I., Perez M.H., Baltussen Weber A., Ceruti S., Marquardt K., Hübner T., Redecker H., Studhalter M., Stephan M., Selz D., Pietsch U., Ristic A., Heise A., Meyer Zu Bentrup F., Franchitti Laurent M., Fodor P., Gaspert T., Haberthuer C., Colak E., Heuberger D.M., Fumeaux T., Montomoli J., Guerci P., Schuepbach R.A., Hilty M.P., Roche-Campo F., Algaba-Calderon A., Apolo J., Aslanidis T., Babik B., Boroli F., Brem J., Brenni M., Brugger S.D., Camen G., Catena E., Ceriani R., Chau I., Christ A., Cogliati C., Concha P., Delahaye G., Drvaric I., Escós-Orta J., Fabbri S., Facondini F., Filipovic M., Gámez-Zapata J., Gerecke P., Gommers D., Hillermann T., Ince C., Jenni-Moser B., Jovic M., Jurkolow G., Klarer A., Lambert A., Laurent J.C., Lavanchy J., Lienhardt-Nobbe B., Locher P., Losser M.R., Lussman R.F., Magliocca A., Margarit A., Martínez A., Mauri R., Mayor-Vázquez E., Meier J., Moret-Bochatay M., Murrone M., Naon D., Neff T., Novy E., Petersen L., Pugin J., Rilinger J., Rimensberger P.C., Sepulcri M., Shaikh K., Sieber M., Simonini M.S., Spadaro S., Sridharan G.O., Stahl K., Staudacher D.L., Taboada-Fraga X., Tellez A., Urech S., Vitale G., Vizmanos-Lamotte G., Welte T., Zalba-Etayo B., Zellweger N.
ISSN
1466-609X (Electronic)
ISSN-L
1364-8535
Publication state
Published
Issued date
25/05/2021
Peer-reviewed
Oui
Volume
25
Number
1
Pages
175
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Publication Status: epublish
Abstract
Uncertainty about the optimal respiratory support strategies in critically ill COVID-19 patients is widespread. While the risks and benefits of noninvasive techniques versus early invasive mechanical ventilation (IMV) are intensely debated, actual evidence is lacking. We sought to assess the risks and benefits of different respiratory support strategies, employed in intensive care units during the first months of the COVID-19 pandemic on intubation and intensive care unit (ICU) mortality rates.
Subanalysis of a prospective, multinational registry of critically ill COVID-19 patients. Patients were subclassified into standard oxygen therapy ≥10 L/min (SOT), high-flow oxygen therapy (HFNC), noninvasive positive-pressure ventilation (NIV), and early IMV, according to the respiratory support strategy employed at the day of admission to ICU. Propensity score matching was performed to ensure comparability between groups.
Initially, 1421 patients were assessed for possible study inclusion. Of these, 351 patients (85 SOT, 87 HFNC, 87 NIV, and 92 IMV) remained eligible for full analysis after propensity score matching. 55% of patients initially receiving noninvasive respiratory support required IMV. The intubation rate was lower in patients initially ventilated with HFNC and NIV compared to those who received SOT (SOT: 64%, HFNC: 52%, NIV: 49%, p = 0.025). Compared to the other respiratory support strategies, NIV was associated with a higher overall ICU mortality (SOT: 18%, HFNC: 20%, NIV: 37%, IMV: 25%, p = 0.016).
In this cohort of critically ill patients with COVID-19, a trial of HFNC appeared to be the most balanced initial respiratory support strategy, given the reduced intubation rate and comparable ICU mortality rate. Nonetheless, considering the uncertainty and stress associated with the COVID-19 pandemic, SOT and early IMV represented safe initial respiratory support strategies. The presented findings, in agreement with classic ARDS literature, suggest that NIV should be avoided whenever possible due to the elevated ICU mortality risk.
Subanalysis of a prospective, multinational registry of critically ill COVID-19 patients. Patients were subclassified into standard oxygen therapy ≥10 L/min (SOT), high-flow oxygen therapy (HFNC), noninvasive positive-pressure ventilation (NIV), and early IMV, according to the respiratory support strategy employed at the day of admission to ICU. Propensity score matching was performed to ensure comparability between groups.
Initially, 1421 patients were assessed for possible study inclusion. Of these, 351 patients (85 SOT, 87 HFNC, 87 NIV, and 92 IMV) remained eligible for full analysis after propensity score matching. 55% of patients initially receiving noninvasive respiratory support required IMV. The intubation rate was lower in patients initially ventilated with HFNC and NIV compared to those who received SOT (SOT: 64%, HFNC: 52%, NIV: 49%, p = 0.025). Compared to the other respiratory support strategies, NIV was associated with a higher overall ICU mortality (SOT: 18%, HFNC: 20%, NIV: 37%, IMV: 25%, p = 0.016).
In this cohort of critically ill patients with COVID-19, a trial of HFNC appeared to be the most balanced initial respiratory support strategy, given the reduced intubation rate and comparable ICU mortality rate. Nonetheless, considering the uncertainty and stress associated with the COVID-19 pandemic, SOT and early IMV represented safe initial respiratory support strategies. The presented findings, in agreement with classic ARDS literature, suggest that NIV should be avoided whenever possible due to the elevated ICU mortality risk.
Keywords
Aged, COVID-19/mortality, COVID-19/therapy, Critical Illness/mortality, Critical Illness/therapy, Disease Progression, Female, Hospital Mortality, Humans, Intensive Care Units, Male, Middle Aged, Prospective Studies, Registries, Respiratory Therapy/methods, Respiratory Therapy/statistics & numerical data, Retrospective Studies, Time Factors, Treatment Outcome, ARDS, COVID-19, High flow oxygen therapy, Invasive mechanical ventilation, Noninvasive mechanical ventilation, Patient self-inflicted lung injury, Respiratory support, Standard oxygen therapy
Pubmed
Web of science
Open Access
Yes
Create date
31/05/2021 7:32
Last modification date
13/09/2023 5:57
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