TY - JOUR
T1 - Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort
AU - Wendel Garcia, Pedro D.
AU - Aguirre-Bermeo, Hernán
AU - Buehler, Philipp K.
AU - Alfaro-Farias, Mario
AU - Yuen, Bernd
AU - David, Sascha
AU - Tschoellitsch, Thomas
AU - Wengenmayer, Tobias
AU - Korsos, Anita
AU - Fogagnolo, Alberto
AU - Kleger, Gian-Reto
AU - Wu, Maddalena A.
AU - Colombo, Riccardo
AU - Turrini, Fabrizio
AU - Potalivo, Antonella
AU - Rezoagli, Emanuele
AU - Rodríguez-García, Raquel
AU - Castro, Pedro
AU - Lander-Azcona, Arantxa
AU - Martín-Delgado, Maria C.
AU - Lozano-Gómez, Herminia
AU - Ensner, Rolf
AU - Michot, Marc P.
AU - Gehring, Nadine
AU - Schott, Peter
AU - Siegemund, Martin
AU - Merki, Lukas
AU - Wiegand, Jan
AU - Jeitziner, Marie M.
AU - Laube, Marcus
AU - Salomon, Petra
AU - Hillgaertner, Frank
AU - Dullenkopf, Alexander
AU - Ksouri, Hatem
AU - Cereghetti, Sara
AU - Grazioli, Serge
AU - Bürkle, Christian
AU - Marrel, Julien
AU - Fleisch, Isabelle
AU - Perez, Marie-Helene
AU - Baltussen Weber, Anja
AU - Ceruti, Samuele
AU - Marquardt, Katharina
AU - Hübner, Tobias
AU - Redecker, Hermann
AU - Studhalter, Michael
AU - Montomoli, Jonathan
AU - Guerci, Philippe
AU - Hilty, Matthias P.
AU - on behalf of RISC-19-ICU Investigators
AU - Ince, Can
N1 - Funding Information: The RISC-19-ICU registry is supported by the Swiss Society of Intensive Care Medicine and funded by internal resources of the Institute of Intensive Care Medicine, of the University Hospital Zurich and by unrestricted grants from CytoSorbents Europe GmbH (Berlin, Germany) and Union Bancaire Privée (Zurich, Switzerland). The sponsors had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Publisher Copyright: © 2021, The Author(s).
PY - 2021/12/1
Y1 - 2021/12/1
N2 - 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.
AB - 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.
KW - ARDS
KW - COVID-19
KW - High flow oxygen therapy
KW - Invasive mechanical ventilation
KW - Noninvasive mechanical ventilation
KW - Patient self-inflicted lung injury
KW - Respiratory support
KW - Standard oxygen therapy
UR - http://www.scopus.com/inward/record.url?scp=85106909379&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s13054-021-03580-y
DO - https://doi.org/10.1186/s13054-021-03580-y
M3 - Article
C2 - 34034782
SN - 1364-8535
VL - 25
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 175
ER -