ABSTRACT
Objectives: To evaluate the impact of combined non-invasive support strategies in critically ill COVID-19 patients [high-flow nasal cannula (HFNC), non-invasive ventilation (NIV) or both]. Method(s): Prospective observational multicenter study in 73 Spanish ICU with data obtained from the SEMICYUC registry. All confirmed COVID-19 patients admitted due to respiratory failure were included. They were classified according to the ventilatory strategy used on admission and subsequently according to success, failure, or strategy change. Demographic data, comorbidities, severity at admission, respiratory, biomarkers, failure, length of stay and mortality were evaluated. Result(s): We analyzed 3,889 patients, 33% receiving HFNC, and 11% NIV at ICU admission. NIV group compared to HFNC were more severely ill with more shock on admission. When NIV was received as a first-choice higher failure rates and mortality were shown vs HFNC (68% vs 61%, p=0.016 and 27% vs 20%, p=0.003). Among patients who initially received HFNC, 57% failed and 7.4% switched to NIV, with no change in mortality. Among patients who were switched to NIV, 66% failed presenting a higher mortality trend than the intubated patients after the HFNC starting (40% vs 30%, p=0.098). Among patients who initially received NIV, 60% failed and 20% switched to HFNC. Patients in whom NIV was switched to HFNC, had lower mortality than patients who initially failed (18% vs 40%, p<0.001). Among patients who were switched to HFNC, 43% failed, presenting the same mortality as the intubated patients after the NIV starting (38% vs 38%, p=0.934). Conclusion(s): Patients receiving NIV at admission have worse outcomes than those receiving HFNC. Changing the strategy in patients who received HFNC as a first choice without success can worsen the prognosis.
ABSTRACT
OBJECTIVE: To determine if the use of corticosteroids was associated with Intensive Care Unit (ICU) mortality among whole population and pre-specified clinical phenotypes. DESIGN: A secondary analysis derived from multicenter, observational study. SETTING: Critical Care Units. PATIENTS: Adult critically ill patients with confirmed COVID-19 disease admitted to 63 ICUs in Spain. INTERVENTIONS: Corticosteroids vs. no corticosteroids. MAIN VARIABLES OF INTEREST: Three phenotypes were derived by non-supervised clustering analysis from whole population and classified as (A: severe, B: critical and C: life-threatening). We performed a multivariate analysis after propensity optimal full matching (PS) for whole population and weighted Cox regression (HR) and Fine-Gray analysis (sHR) to assess the impact of corticosteroids on ICU mortality according to the whole population and distinctive patient clinical phenotypes. RESULTS: A total of 2017 patients were analyzed, 1171 (58%) with corticosteroids. After PS, corticosteroids were shown not to be associated with ICU mortality (OR: 1.0; 95% CI: 0.98-1.15). Corticosteroids were administered in 298/537 (55.5%) patients of "A" phenotype and their use was not associated with ICU mortality (HR=0.85 [0.55-1.33]). A total of 338/623 (54.2%) patients in "B" phenotype received corticosteroids. No effect of corticosteroids on ICU mortality was observed when HR was performed (0.72 [0.49-1.05]). Finally, 535/857 (62.4%) patients in "C" phenotype received corticosteroids. In this phenotype HR (0.75 [0.58-0.98]) and sHR (0.79 [0.63-0.98]) suggest a protective effect of corticosteroids on ICU mortality. CONCLUSION: Our finding warns against the widespread use of corticosteroids in all critically ill patients with COVID-19 at moderate dose. Only patients with the highest inflammatory levels could benefit from steroid treatment.
ABSTRACT
Objective To determine if the use of corticosteroids was associated with Intensive Care Unit (ICU) mortality among whole population and pre-specified clinical phenotypes. Design A secondary analysis derived from multicenter, observational study. Setting Critical Care Units. Patients Adult critically ill patients with confirmed COVID-19 disease admitted to 63 ICUs in Spain. Interventions Corticosteroids vs. no corticosteroids. Main variables of interest Three phenotypes were derived by non-supervised clustering analysis from whole population and classified as (A: severe, B: critical and C: life-threatening). We performed a multivariate analysis after propensity optimal full matching (PS) for whole population and weighted Cox regression (HR) and Fine-Gray analysis (sHR) to assess the impact of corticosteroids on ICU mortality according to the whole population and distinctive patient clinical phenotypes. Results A total of 2017 patients were analyzed, 1171 (58%) with corticosteroids. After PS, corticosteroids were shown not to be associated with ICU mortality (OR: 1.0;95% CI: 0.98–1.15). Corticosteroids were administered in 298/537 (55.5%) patients of “A” phenotype and their use was not associated with ICU mortality (HR = 0.85 [0.55–1.33]). A total of 338/623 (54.2%) patients in “B” phenotype received corticosteroids. No effect of corticosteroids on ICU mortality was observed when HR was performed (0.72 [0.49–1.05]). Finally, 535/857 (62.4%) patients in “C” phenotype received corticosteroids. In this phenotype HR (0.75 [0.58–0.98]) and sHR (0.79 [0.63–0.98]) suggest a protective effect of corticosteroids on ICU mortality. Conclusion Our finding warns against the widespread use of corticosteroids in all critically ill patients with COVID-19 at moderate dose. Only patients with the highest inflammatory levels could benefit from steroid treatment.
ABSTRACT
HEMOCOVID-19 is a multi-center trial aiming to assess the microvascular and endothelial health of severe COVID-19 patients in the intensive care using near-infrared spectroscopy. Here, we present the preliminary results, showing that peripheral microcirculatory alterations are associated with the severity of acute respiratory distress syndrome. © 2022 The Author(s).