1. Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort
- Author
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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., Rodriguez-Garcia R., Castro P., Lander-Azcona A., Martin-Delgado M. C., Lozano-Gomez 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., Burkle C., Marrel J., Fleisch I., Perez M. -H., Baltussen Weber A., Ceruti S., Marquardt K., Hubner 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., Escos-Orta J., Fabbri S., Facondini F., Filipovic M., Gamez-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., Martinez A., Mauri R., Mayor-Vazquez E., Meier J., Moret-Bochatay M., Murrone M., Naon D., Neff T., Novy E., Petersen L., Pugin J., Ramelet A. -S., 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., Graduate School, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, AII - Inflammatory diseases, RISC-19-ICU Investigators, 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., Ramelet, A.S., 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., Wendel Garcia, P, Aguirre-Bermeo, H, Buehler, P, Alfaro-Farias, M, Yuen, B, David, S, Tschoellitsch, T, Wengenmayer, T, Korsos, A, Fogagnolo, A, Kleger, G, Wu, M, Colombo, R, Turrini, F, Potalivo, A, Rezoagli, E, Rodriguez-Garcia, R, Castro, P, Lander-Azcona, A, Martin-Delgado, M, Lozano-Gomez, H, Ensner, R, Michot, M, Gehring, N, Schott, P, Siegemund, M, Merki, L, Wiegand, J, Jeitziner, M, Laube, M, Salomon, P, Hillgaertner, F, Dullenkopf, A, Ksouri, H, Cereghetti, S, Grazioli, S, Burkle, C, Marrel, J, Fleisch, I, Perez, M, Baltussen Weber, A, Ceruti, S, Marquardt, K, Hubner, 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, Fumeaux, T, Montomoli, J, Guerci, P, Schuepbach, R, Hilty, M, Roche-Campo, F, Algaba-Calderon, A, Apolo, J, Aslanidis, T, Babik, B, Boroli, F, Brem, J, Brenni, M, Brugger, S, Camen, G, Catena, E, Ceriani, R, Chau, I, Christ, A, Cogliati, C, Concha, P, Delahaye, G, Drvaric, I, Escos-Orta, J, Fabbri, S, Facondini, F, Filipovic, M, Gamez-Zapata, J, Gerecke, P, Gommers, D, Hillermann, T, Ince, C, Jenni-Moser, B, Jovic, M, Jurkolow, G, Klarer, A, Lambert, A, Laurent, J, Lavanchy, J, Lienhardt-Nobbe, B, Locher, P, Losser, M, Lussman, R, Magliocca, A, Margarit, A, Martinez, A, Mauri, R, Mayor-Vazquez, E, Meier, J, Moret-Bochatay, M, Murrone, M, Naon, D, Neff, T, Novy, E, Petersen, L, Pugin, J, Ramelet, A, Rilinger, J, Rimensberger, P, Sepulcri, M, Shaikh, K, Sieber, M, Simonini, M, Spadaro, S, Sridharan, G, Stahl, K, Staudacher, D, Taboada-Fraga, X, Tellez, A, Urech, S, Vitale, G, Vizmanos-Lamotte, G, Welte, T, Zalba-Etayo, B, Zellweger, N, and Intensive Care
- Subjects
Male ,ARDS ,Time Factors ,medicine.medical_treatment ,Old age ,Critical Care and Intensive Care Medicine ,law.invention ,0302 clinical medicine ,law ,Oxygen therapy ,Noninvasive mechanical ventilation ,Intubation ,030212 general & internal medicine ,Hospital Mortality ,Prospective Studies ,Registries ,Prospective cohort study ,610 Medicine & health ,Unitats de cures intensives ,Intensive care units ,Medical emergencies. Critical care. Intensive care. First aid ,Middle Aged ,Intensive care unit ,Intensive Care Units ,Treatment Outcome ,Vellesa ,High flow oxygen therapy ,Disease Progression ,Female ,Standard oxygen therapy ,medicine.medical_specialty ,Respiratory Therapy ,Critical Illness ,NO ,03 medical and health sciences ,Intensive care ,medicine ,Humans ,Invasive mechanical ventilation ,Critically ill ,Patient self-inflicted lung injury ,Aged ,Retrospective Studies ,Mechanical ventilation ,COVID-19/mortality ,COVID-19/therapy ,Critical Illness/mortality ,Critical Illness/therapy ,Respiratory Therapy/methods ,Respiratory Therapy/statistics & numerical data ,COVID-19 ,Respiratory support ,business.industry ,RC86-88.9 ,Research ,Retrospective cohort study ,medicine.disease ,Malalts en estat crític ,030228 respiratory system ,Emergency medicine ,business - Abstract
Background 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. Methods 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. Results 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). Conclusion 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.
- Published
- 2021