TY - JOUR
T1 - Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID)
T2 - a national, multicentre, observational cohort study
AU - PRoVENT-COVID Collaborative Group
AU - Botta, Michela
AU - Tsonas, Anissa M
AU - Pillay, Janesh
AU - Boers, Leonoor S
AU - Algera, Anna Geke
AU - Bos, Lieuwe D J
AU - Dongelmans, Dave A
AU - Hollmann, Marcus W
AU - Horn, Janneke
AU - Vlaar, Alexander P J
AU - Schultz, Marcus J
AU - Neto, Ary Serpa
AU - Paulus, Frederique
AU - Stilma, W.
AU - van Akkeren, Jesse P.
AU - Algoe, Cheetel K.
AU - van Amstel, Rombout B.
AU - Baur, Onno L.
AU - van de Berg, Pablo
AU - van den Berg, Alida E.
AU - Bergmans, Dennis C.J.J.
AU - van den Bersselaar, Dido I.
AU - Bertens, Freke A.
AU - Bindels, Alexander J.G.H.
AU - de Boer, Milou M.
AU - den Boer, Sylvia
AU - Bogerd, Margriet
AU - Breel, Jennifer S.
AU - de Bruin, Hendrik
AU - de Bruin, Sanne
AU - Bruna, Caro L.
AU - Buiteman-Kruizinga, Laura A.
AU - Cremer, Olaf L.
AU - Determann, Rogier M.
AU - Dieperink, Willem
AU - Franke, Hildegard S.
AU - Galek-Aldridge, Michal S.
AU - de Graaff, Mart J.
AU - Hagens, Laura A.
AU - Haringman, Jasper J.
AU - van der Heide, Sebastiaan T.
AU - van der Heiden, Pim L.J.
AU - Heijnen, Nanon F.L.
AU - Hiel, Stephan J.P.
AU - Hoeijmakers, Lotte L.
AU - Hol, Liselotte
AU - Hollmann, Markus W.
AU - Hoogendoorn, Marga E.
AU - van der Horst, Robrecht
AU - Ie, Evy L.K.
AU - Ivanov, Dimitri P.
AU - Juffermans, Nicole
AU - Kho, Eline
AU - de Klerk, Eline S.
AU - Koopman-van Gemert, Ankie W.M.M.
AU - Koopmans, Matty
AU - Kucukcelebi, Songul
AU - Kuiper, Michael A.
AU - de Lange, Dylan W.
AU - van Mourik, Niels
AU - Nijbroek, Sunny G.L.H.
AU - Onrust, Marisa
AU - Oostdijk, Evelien A.N.
AU - Pennartz, Charlotte J.
AU - Pisani, Luigi
AU - Purmer, Ilse M.
AU - Rettig, Thijs C.D.
AU - Roozeman, Jan Paul
AU - Schuijt, Michiel T.U.
AU - Sleeswijk, Mengalvio E.
AU - Smit, Marry R.
AU - Spronk, Peter E.
AU - Strang, Aart C.
AU - Tuinman, Pieter R.
AU - Valk, Christel M.A.
AU - Veen-Schra, Felicia L.
AU - Veldhuis, Lars I.
AU - van Velzen, Patricia
AU - van der Ven, Ward H.
AU - van Vliet, Peter
AU - van der Voort, Peter H.J.
AU - van Welie, Louis
AU - Wesselink, Henrico J.F.T.
AU - van der Wier-Lubbers, Hermien H.
AU - van Wijk, Bas
AU - Winters, Tineke
AU - Wong, Wing Yi
AU - van Zanten, Arthur R.H.
N1 - Funding Information: LDJB reports grants from Health Holland and Dutch Lung Foundation, Dutch Lung Foundation, Amsterdam UMC, and Innovative Medicine Initiative, outside the submitted work. MWH reports non-financial support for his role as Executive Section Editor for Pharmacology with Anesthesia & Analgesia and as Section Editor for Anesthesiology with the Journal of Clinical Medicine; and grants from Edwards Life Sciences, Eurocept, ZonMW, and CSL Behring, outside the submitted work. ASN reports personal fees from Dräger, outside the submitted work. All other authors declare no competing interests. Publisher Copyright: © 2021 Elsevier Ltd
PY - 2021/2/1
Y1 - 2021/2/1
N2 - BACKGROUND: Little is known about the practice of ventilation management in patients with COVID-19. We aimed to describe the practice of ventilation management and to establish outcomes in invasively ventilated patients with COVID-19 in a single country during the first month of the outbreak.METHODS: PRoVENT-COVID is a national, multicentre, retrospective observational study done at 18 intensive care units (ICUs) in the Netherlands. Consecutive patients aged at least 18 years were eligible for participation if they had received invasive ventilation for COVID-19 at a participating ICU during the first month of the national outbreak in the Netherlands. The primary outcome was a combination of ventilator variables and parameters over the first 4 calendar days of ventilation: tidal volume, positive end-expiratory pressure (PEEP), respiratory system compliance, and driving pressure. Secondary outcomes included the use of adjunctive treatments for refractory hypoxaemia and ICU complications. Patient-centred outcomes were ventilator-free days at day 28, duration of ventilation, duration of ICU and hospital stay, and mortality. PRoVENT-COVID is registered at ClinicalTrials.gov (NCT04346342).FINDINGS: Between March 1 and April 1, 2020, 553 patients were included in the study. Median tidal volume was 6·3 mL/kg predicted bodyweight (IQR 5·7-7·1), PEEP was 14·0 cm H2O (IQR 11·0-15·0), and driving pressure was 14·0 cm H2O (11·2-16·0). Median respiratory system compliance was 31·9 mL/cm H2O (26·0-39·9). Of the adjunctive treatments for refractory hypoxaemia, prone positioning was most often used in the first 4 days of ventilation (283 [53%] of 530 patients). The median number of ventilator-free days at day 28 was 0 (IQR 0-15); 186 (35%) of 530 patients had died by day 28. Predictors of 28-day mortality were gender, age, tidal volume, respiratory system compliance, arterial pH, and heart rate on the first day of invasive ventilation.INTERPRETATION: In patients with COVID-19 who were invasively ventilated during the first month of the outbreak in the Netherlands, lung-protective ventilation with low tidal volume and low driving pressure was broadly applied and prone positioning was often used. The applied PEEP varied widely, despite an invariably low respiratory system compliance. The findings of this national study provide a basis for new hypotheses and sample size calculations for future trials of invasive ventilation for COVID-19. These data could also help in the interpretation of findings from other studies of ventilation practice and outcomes in invasively ventilated patients with COVID-19.FUNDING: Amsterdam University Medical Centers, location Academic Medical Center.
AB - BACKGROUND: Little is known about the practice of ventilation management in patients with COVID-19. We aimed to describe the practice of ventilation management and to establish outcomes in invasively ventilated patients with COVID-19 in a single country during the first month of the outbreak.METHODS: PRoVENT-COVID is a national, multicentre, retrospective observational study done at 18 intensive care units (ICUs) in the Netherlands. Consecutive patients aged at least 18 years were eligible for participation if they had received invasive ventilation for COVID-19 at a participating ICU during the first month of the national outbreak in the Netherlands. The primary outcome was a combination of ventilator variables and parameters over the first 4 calendar days of ventilation: tidal volume, positive end-expiratory pressure (PEEP), respiratory system compliance, and driving pressure. Secondary outcomes included the use of adjunctive treatments for refractory hypoxaemia and ICU complications. Patient-centred outcomes were ventilator-free days at day 28, duration of ventilation, duration of ICU and hospital stay, and mortality. PRoVENT-COVID is registered at ClinicalTrials.gov (NCT04346342).FINDINGS: Between March 1 and April 1, 2020, 553 patients were included in the study. Median tidal volume was 6·3 mL/kg predicted bodyweight (IQR 5·7-7·1), PEEP was 14·0 cm H2O (IQR 11·0-15·0), and driving pressure was 14·0 cm H2O (11·2-16·0). Median respiratory system compliance was 31·9 mL/cm H2O (26·0-39·9). Of the adjunctive treatments for refractory hypoxaemia, prone positioning was most often used in the first 4 days of ventilation (283 [53%] of 530 patients). The median number of ventilator-free days at day 28 was 0 (IQR 0-15); 186 (35%) of 530 patients had died by day 28. Predictors of 28-day mortality were gender, age, tidal volume, respiratory system compliance, arterial pH, and heart rate on the first day of invasive ventilation.INTERPRETATION: In patients with COVID-19 who were invasively ventilated during the first month of the outbreak in the Netherlands, lung-protective ventilation with low tidal volume and low driving pressure was broadly applied and prone positioning was often used. The applied PEEP varied widely, despite an invariably low respiratory system compliance. The findings of this national study provide a basis for new hypotheses and sample size calculations for future trials of invasive ventilation for COVID-19. These data could also help in the interpretation of findings from other studies of ventilation practice and outcomes in invasively ventilated patients with COVID-19.FUNDING: Amsterdam University Medical Centers, location Academic Medical Center.
UR - http://www.scopus.com/inward/record.url?scp=85096368082&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/S2213-2600(20)30459-8
DO - https://doi.org/10.1016/S2213-2600(20)30459-8
M3 - Article
C2 - 33169671
SN - 2213-2600
VL - 9
SP - 139
EP - 148
JO - The Lancet. Respiratory medicine
JF - The Lancet. Respiratory medicine
IS - 2
ER -