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Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID): a national, multicentre, observational cohort study.
Botta, Michela; Tsonas, Anissa M; Pillay, Janesh; Boers, Leonoor S; Algera, Anna Geke; Bos, Lieuwe D J; Dongelmans, Dave A; Hollmann, Marcus W; Horn, Janneke; Vlaar, Alexander P J; Schultz, Marcus J; Neto, Ary Serpa; Paulus, Frederique.
  • Botta M; Department of Intensive Care, Amsterdam University Medical Centers location Academic Medical Center, Amsterdam, Netherlands.
  • Tsonas AM; Department of Intensive Care, Amsterdam University Medical Centers location Academic Medical Center, Amsterdam, Netherlands.
  • Pillay J; Department of Intensive Care, Amsterdam University Medical Centers location Academic Medical Center, Amsterdam, Netherlands; University Medical Center Groningen, Groningen, The Netherlands.
  • Boers LS; Department of Intensive Care, Amsterdam University Medical Centers location Academic Medical Center, Amsterdam, Netherlands.
  • Algera AG; Department of Intensive Care, Amsterdam University Medical Centers location Academic Medical Center, Amsterdam, Netherlands.
  • Bos LDJ; Department of Intensive Care, Amsterdam University Medical Centers location Academic Medical Center, Amsterdam, Netherlands.
  • Dongelmans DA; Department of Intensive Care, Amsterdam University Medical Centers location Academic Medical Center, Amsterdam, Netherlands.
  • Hollmann MW; Department of Anaesthesiology, Amsterdam University Medical Centers location Academic Medical Center, Amsterdam, Netherlands.
  • Horn J; Department of Intensive Care, Amsterdam University Medical Centers location Academic Medical Center, Amsterdam, Netherlands.
  • Vlaar APJ; Department of Intensive Care, Amsterdam University Medical Centers location Academic Medical Center, Amsterdam, Netherlands.
  • Schultz MJ; Department of Intensive Care, Amsterdam University Medical Centers location Academic Medical Center, Amsterdam, Netherlands; Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, UK. Electronic address: m
  • Neto AS; Department of Intensive Care, Amsterdam University Medical Centers location Academic Medical Center, Amsterdam, Netherlands; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Austin Hospital and University of Melbourne, Melbourne, VIC, Australia.
  • Paulus F; Department of Intensive Care, Amsterdam University Medical Centers location Academic Medical Center, Amsterdam, Netherlands; ACHIEVE, Centre of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, Netherlands.
Lancet Respir Med ; 9(2): 139-148, 2021 02.
Article in English | MEDLINE | ID: covidwho-1065695
Semantic information from SemMedBD (by NLM)
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ABSTRACT

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.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / COVID-19 Type of study: Controlled clinical trial / Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Lancet Respir Med Year: 2021 Document Type: Article Affiliation country: S2213-2600(20)30459-8

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / COVID-19 Type of study: Controlled clinical trial / Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Lancet Respir Med Year: 2021 Document Type: Article Affiliation country: S2213-2600(20)30459-8