@article{d8bbc88ad70d4095a72bf413b46f79f3,
title = "Association of intensity of ventilation with 28-day mortality in COVID-19 patients with acute respiratory failure: insights from the PRoVENT-COVID study",
abstract = "Background: The intensity of ventilation, reflected by driving pressure (ΔP) and mechanical power (MP), has an association with outcome in invasively ventilated patients with or without acute respiratory distress syndrome (ARDS). It is uncertain if a similar association exists in coronavirus disease 2019 (COVID-19) patients with acute respiratory failure. Methods: We aimed to investigate the impact of intensity of ventilation on patient outcome. The PRoVENT-COVID study is a national multicenter observational study in COVID-19 patients receiving invasive ventilation. Ventilator parameters were collected a fixed time points on the first calendar day of invasive ventilation. Mean dynamic ΔP and MP were calculated for individual patients at time points without evidence of spontaneous breathing. A Cox proportional hazard model, and a double stratification analysis adjusted for confounders were used to estimate the independent associations of ΔP and MP with outcome. The primary endpoint was 28-day mortality. Results: In 825 patients included in this analysis, 28-day mortality was 27.5%. ΔP was not independently associated with mortality (HR 1.02 [95% confidence interval 0.88–1.18]; P = 0.750). MP, however, was independently associated with 28-day mortality (HR 1.17 [95% CI 1.01–1.36]; P = 0.031), and increasing quartiles of MP, stratified on comparable levels of ΔP, had higher risks of 28-day mortality (HR 1.15 [95% CI 1.01–1.30]; P = 0.028). Conclusions: In this cohort of critically ill invasively ventilated COVID-19 patients with acute respiratory failure, we show an independent association of MP, but not ΔP with 28-day mortality. MP could serve as one prognostic biomarker in addition to ΔP in these patients. Efforts aiming at limiting both ΔP and MP could translate in a better outcome. Trial registration Clinicaltrials.gov (study identifier NCT04346342). [Figure not available: see fulltext.]",
keywords = "Acute respiratory failure, COVID-19, Coronavirus disease 2019, Driving pressure, ICU, Invasive ventilation, Mechanical power, Mechanical power of ventilation, Mortality, ΔP",
author = "Schuijt, {Michiel T. U.} and Schultz, {Marcus J.} and Frederique Paulus and {Serpa Neto}, Ary and {van Akkeren}, {J. P.} and {PRoVENT–COVID Collaborative Group} and Algera, {A. G.} and Algoe, {C. K.} and {van Amstel}, {R. B.} and Baur, {O. L.} and {van de Berg}, P. and Bergmans, {D. C. J. J.} and {van den Bersselaar}, {D. I.} and Bertens, {F. A.} and Bindels, {A. J. G. H.} and {de Boer}, {M. M.} and Boer, {S. den} and Boers, {L. S.} and M. Bogerd and Bos, {L. D. J.} and M. Botta and Breel, {J. S.} and {de Bruin}, H. and {de Bruin}, S. and Bruna, {C. L.} and Buiteman-Kruizinga, {L. A.} and O. Cremer and Determann, {R. M.} and W. Dieperink and Dongelmans, {D. A.} and Franke, {H. S.} and Aldridge, {M. S. Galek} and {de Graaff}, {M. J.} and Hagens, {L. A.} and Haringman, {J. J.} and Heijnen, {N. F. L.} and S. Hiel and {van der Heide}, {S. T.} and {van der Heiden}, {P. L. J.} and Hoeijmakers, {L. L.} and L. Hol and Hollmann, {M. W.} and Hoogendoorn, {M. E.} and J. Horn and {van der Horst}, R. and Ie, {E. L. K.} and D. Ivanov and S. Kucukcelebi and J. Pillay and Rettig, {T. C. D.} and Tuinman, {P. R.} and Juffermans, {N. P.} and E. Kho and {de Klerk}, {E. S.} and Kuiper, {M. A.} and {van Meenen}, {D. M.} and Guido Mazzinari and {van Mourik}, N. and L. Pisani and Purmer, {I. M.} and Spronk, {P. E.} and W. Stilma and Vlaar, {A. P. J.} and {van Velzen}, P.",
note = "Funding Information: The authors would like to state a special gratitude towards all participating centers and all members of the PRoVENT-COVID Collaborative Group. The PRoVENT-COVID Collaborative Group investigators in alphabetic order: J.P. van Akkeren; A.G. Algera; C.K. Algoe; R.B. van Amstel; O.L. Baur; P. van de Berg; A.E. van den Berg; D.C.J.J. Bergmans; D.I. van den Bersselaar; F.A. Bertens; A.J.G.H. Bindels; M.M. de Boer; S. den Boer; L.S. Boers; M. Bogerd; L.D.J. Bos; M. Botta; J.S. Breel; H. de Bruin; S. de Bruin; C.L. Bruna; L.A. Buiteman?Kruizinga; O. Cremer; R.M. Determann; W. Dieperink; D.A. Dongelmans; H.S. Franke; M.S. Galek?Aldridge; M.J. de Graaff; L.A. Hagens; J.J. Haringman; N.F.L.Heijnen; S.Hiel; S.T. van der Heide; P.L.J. van der Heiden; L.L. Hoeijmakers; L. Hol; M. W. Hollmann; M.E. Hoogendoorn; J. Horn; R. van der Horst; E.L.K. Ie; D. Ivanov; N.P. Juffermans; E. Kho; E.S. de Klerk; A.W.M. Koopman; M. Koopmans; S. Kucukcelebi; M.A. Kuiper; D.W. de Lange; D. M. van Meenen; Ignacio Martin-Loeches; Guido Mazzinari; N. van Mourik; I. Martin?Loeches; S.G. Nijbroe; M. Onrust; E.A.N. Oostdijk; F. Paulus; C.J. Pennartz; J. Pillay; L. Pisani; I.M. Purmer; T.C.D. Rettig; J.P Roozeman; M.T.U. Schuijt; M.J. Schultz; A. Serpa Neto; M.E. Sleeswijk; M.R. Smit; P.E. Spronk; W. Stilma; A.C. Strang; A. M. Tsonas; P.R Tuinman; C.M.A. Valk; F.L.Veen; A.P.J. Vlaar; L.I. Veldhuis; P. van Velzen; W.H. van der Ven; P. van Vliet; P. van der Voort; H.H. van der Wier; L. van Welie; H.J.F.T. Wesselink; B. van Wijk; T. Winters; W.Y. Wong; A.R.H. van Zanten. Publisher Copyright: {\textcopyright} 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",
year = "2021",
month = dec,
day = "1",
doi = "https://doi.org/10.1186/s13054-021-03710-6",
language = "English",
volume = "25",
pages = "283",
journal = "Critical Care",
issn = "1364-8535",
publisher = "Springer Science + Business Media",
number = "1",
}