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Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort.
Wendel Garcia, Pedro D; Aguirre-Bermeo, Hernán; Buehler, Philipp K; Alfaro-Farias, Mario; Yuen, Bernd; David, Sascha; Tschoellitsch, Thomas; Wengenmayer, Tobias; Korsos, Anita; Fogagnolo, Alberto; Kleger, Gian-Reto; Wu, Maddalena A; Colombo, Riccardo; Turrini, Fabrizio; Potalivo, Antonella; Rezoagli, Emanuele; Rodríguez-García, Raquel; Castro, Pedro; Lander-Azcona, Arantxa; Martín-Delgado, Maria C; Lozano-Gómez, Herminia; Ensner, Rolf; Michot, Marc P; Gehring, Nadine; Schott, Peter; Siegemund, Martin; Merki, Lukas; Wiegand, Jan; Jeitziner, Marie M; Laube, Marcus; Salomon, Petra; Hillgaertner, Frank; Dullenkopf, Alexander; Ksouri, Hatem; Cereghetti, Sara; Grazioli, Serge; Bürkle, Christian; Marrel, Julien; Fleisch, Isabelle; Perez, Marie-Helene; Baltussen Weber, Anja; Ceruti, Samuele; Marquardt, Katharina; Hübner, Tobias; Redecker, Hermann; Studhalter, Michael; Stephan, Michael; Selz, Daniela; Pietsch, Urs; Ristic, Anette.
  • Wendel Garcia PD; Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.
  • Aguirre-Bermeo H; The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland.
  • Buehler PK; Unidad de Cuidados Intensivos, Hospital Vicente Corral Moscoso, Cuenca, Ecuador.
  • Alfaro-Farias M; Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.
  • Yuen B; Unidad de Cuidados Intensivos, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra.
  • David S; Interdisziplinaere Intensivstation, Spital Buelach, Buelach, Switzerland.
  • Tschoellitsch T; Department of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany.
  • Wengenmayer T; Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH and Johannes Kepler University, Linz, Austria.
  • Korsos A; Department of Medicine III - Interdisciplinary Medical Intensive Care, Medical Center University of Freiburg, Freiburg, Germany.
  • Fogagnolo A; Departement of Anaethesiology and Intensive Care, University of Szeged, Szeged, Hungary.
  • Kleger GR; Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy.
  • Wu MA; Medizinische Intensivstation, Kantonsspital St. Gallen, St. Gallen, Switzerland.
  • Colombo R; Department of Internal Medicine, ASST Fatebenefratelli Sacco - "Luigi Sacco" Hospital, Milan, Italy.
  • Turrini F; Division of Anesthesia and Intensive Care, ASST Fatebenefratelli Sacco - "Luigi Sacco" Hospital, Milan, Italy.
  • Potalivo A; Internal Medicine, Azienda Ospedaliera Universitaria di Modena, Modena, Italy.
  • Rezoagli E; UOC Anestesia e Rianimazione, Ospedale Infermi, Rimini, Italy.
  • Rodríguez-García R; Department of Anesthesia and Intensive Care Medicine, Policlinico San Marco, Gruppo Ospedaliero San Donato, Bergamo, Italy.
  • Castro P; Servicio de Medicina intensiva, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
  • Lander-Azcona A; Medical Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain.
  • Martín-Delgado MC; Servicio de Medicina Intensiva, Hospital General San Jorge, Huesca, Spain.
  • Lozano-Gómez H; Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid, Spain.
  • Ensner R; Unidad de Cuidados Intensivos, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
  • Michot MP; Klinik für Operative Intensivmedizin, Kantonsspital Aarau, Aarau, Switzerland.
  • Gehring N; Medizinische Intensivstation, Kantonsspital Aarau, Aarau, Switzerland.
  • Schott P; Intensivstation, Kantonsspital Schaffhausen, Schaffhausen, Switzerland.
  • Siegemund M; Institut fuer Anesthaesie und Intensivmedizin, Zuger Kantonsspital AG, Baar, Switzerland.
  • Merki L; Department Intensivmedizin, Universitaetsspital Basel, Basel, Switzerland.
  • Wiegand J; Intensivmedizin, St. Claraspital, Basel, Switzerland.
  • Jeitziner MM; Interdisziplinaere Intensivmedizin, Lindenhofspital, Bern, Switzerland.
  • Laube M; Department of Intensive Care Medicine, University Hospital Bern, Inselspital, Bern, Switzerland.
  • Salomon P; Department Intensive Care Medicine, Spitalzentrum Biel, Biel, Switzerland.
  • Hillgaertner F; Intensivstation, Regionalspital Emmental AG, Burgdorf, Switzerland.
  • Dullenkopf A; Intensivmedizin, Kantonsspital Graubuenden, Chur, Switzerland.
  • Ksouri H; Institut fuer Anaesthesie und Intensivmedizin, Spital Thurgau, Frauenfeld, Switzerland.
  • Cereghetti S; Soins Intensifs, Hopital cantonal de Fribourg, Fribourg, Switzerland.
  • Grazioli S; Division of Intensive Care, University Hospitals of Geneva, Geneva, Switzerland.
  • Bürkle C; Division of Neonatal and Pediatric Intensive Care, University Hospitals of Geneva, Geneva, Switzerland.
  • Marrel J; Intensivstation, Spital Grabs, Grabs, Switzerland.
  • Fleisch I; Institut für Anaesthesiologie Intensivmedizin & Rettungsmedizin, See-Spital Horgen & Kilchberg, Horgen, Switzerland.
  • Perez MH; Soins Intensifs, Hirslanden Clinique Cecil, Lausanne, Switzerland.
  • Baltussen Weber A; Pediatric Intensive Care Unit, University Hospital Lausanne, Lausanne, Switzerland.
  • Ceruti S; Anaesthesie und Intensivmedizin, Kantonsspital Baselland, Liestal, Switzerland.
  • Marquardt K; Dipartimento Area Critica, Clinica Luganese Moncucco, Lugano, Switzerland.
  • Hübner T; Interdisziplinaere Intensivstation, Spital Maennedorf AG, Maennedorf, Switzerland.
  • Redecker H; Institut fuer Anaesthesie und Intensivmedizin, Spital Thurgau, Muensterlingen, Switzerland.
  • Studhalter M; Intensivmedizin, Schweizer Paraplegikerzentrum Nottwil, Nottwil, Switzerland.
  • Stephan M; Intensivmedizin & Intermediate Care, Kantonsspital Olten, Olten, Switzerland.
  • Selz D; Intensivmedizin, Spital Oberengadin, Samedan, Switzerland.
  • Pietsch U; Anaesthesie Intensivmedizin Schmerzmedizin, Spital Schwyz, Schwyz, Switzerland.
  • Ristic A; Departement of Anesthesiology and Intensive Care Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Crit Care ; 25(1): 175, 2021 05 25.
Article in English | MEDLINE | ID: covidwho-1243815
Semantic information from SemMedBD (by NLM)
1. Disease Progression COEXISTS_WITH COVID-19
Subject
Disease Progression
Predicate
COEXISTS_WITH
Object
COVID-19
2. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
3. Uncertainty PROCESS_OF Patients
Subject
Uncertainty
Predicate
PROCESS_OF
Object
Patients
4. Critical Illness PROCESS_OF Patients
Subject
Critical Illness
Predicate
PROCESS_OF
Object
Patients
5. COVID-19 COEXISTS_WITH Stress
Subject
COVID-19
Predicate
COEXISTS_WITH
Object
Stress
6. COVID-19 COEXISTS_WITH Uncertainty
Subject
COVID-19
Predicate
COEXISTS_WITH
Object
Uncertainty
7. Disease Progression COEXISTS_WITH COVID-19
Subject
Disease Progression
Predicate
COEXISTS_WITH
Object
COVID-19
8. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
9. Uncertainty PROCESS_OF Patients
Subject
Uncertainty
Predicate
PROCESS_OF
Object
Patients
10. Critical Illness PROCESS_OF Patients
Subject
Critical Illness
Predicate
PROCESS_OF
Object
Patients
11. COVID-19 COEXISTS_WITH Stress
Subject
COVID-19
Predicate
COEXISTS_WITH
Object
Stress
12. COVID-19 COEXISTS_WITH Uncertainty
Subject
COVID-19
Predicate
COEXISTS_WITH
Object
Uncertainty
ABSTRACT

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.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Therapy / Critical Illness / COVID-19 Type of study: Observational study / Randomized controlled trials / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Crit Care Year: 2021 Document Type: Article Affiliation country: S13054-021-03580-y

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Therapy / Critical Illness / COVID-19 Type of study: Observational study / Randomized controlled trials / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Crit Care Year: 2021 Document Type: Article Affiliation country: S13054-021-03580-y