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Protective ventilation and outcomes of critically ill patients with COVID-19: a cohort study.
Ferreira, Juliana C; Ho, Yeh-Li; Besen, Bruno Adler Maccagnan Pinheiro; Malbouisson, Luiz Marcelo Sa; Taniguchi, Leandro Utino; Mendes, Pedro Vitale; Costa, Eduardo Leite Vieira; Park, Marcelo; Daltro-Oliveira, Renato; Roepke, Roberta M L; Silva-Jr, Joao M; Carmona, Maria Jose Carvalho; Carvalho, Carlos R R.
  • Ferreira JC; Divisao de Pneumologia, Instituto Do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil. Juliana.ferreira@hc.fm.usp.br.
  • Ho YL; Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil. Juliana.ferreira@hc.fm.usp.br.
  • Besen BAMP; Divisao de Molestias Infecciosas, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
  • Malbouisson LMS; Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
  • Taniguchi LU; Divisao de Anestesia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
  • Mendes PV; Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
  • Costa ELV; Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
  • Park M; Divisao de Pneumologia, Instituto Do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil.
  • Daltro-Oliveira R; Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
  • Roepke RML; Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil.
  • Silva-Jr JM; Divisao de Molestias Infecciosas, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
  • Carmona MJC; Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil.
  • Carvalho CRR; UTI Emergencias Cirurgicas E Trauma, Departamento de Cirurgia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Ann Intensive Care ; 11(1): 92, 2021 Jun 07.
Article in English | MEDLINE | ID: covidwho-1259216
ABSTRACT

BACKGROUND:

Approximately 5% of COVID-19 patients develop respiratory failure and need ventilatory support, yet little is known about the impact of mechanical ventilation strategy in COVID-19. Our objective was to describe baseline characteristics, ventilatory parameters, and outcomes of critically ill patients in the largest referral center for COVID-19 in Sao Paulo, Brazil, during the first surge of the pandemic.

METHODS:

This cohort included COVID-19 patients admitted to the intensive care units (ICUs) of an academic hospital with 94 ICU beds, a number expanded to 300 during the pandemic as part of a state preparedness plan. Data included demographics, advanced life support therapies, and ventilator parameters. The main outcome was 28-day survival. We used a multivariate Cox model to test the association between protective ventilation and survival, adjusting for PF ratio, pH, compliance, and PEEP.

RESULTS:

We included 1503 patients from March 30 to June 30, 2020. The mean age was 60 ± 15 years, and 59% were male. During 28-day follow-up, 1180 (79%) patients needed invasive ventilation and 666 (44%) died. For the 984 patients who were receiving mechanical ventilation in the first 24 h of ICU stay, mean tidal volume was 6.5 ± 1.3 mL/kg of ideal body weight, plateau pressure was 24 ± 5 cmH2O, respiratory system compliance was 31.9 (24.4-40.9) mL/cmH2O, and 82% of patients were ventilated with protective ventilation. Noninvasive ventilation was used in 21% of patients, and prone, in 36%. Compliance was associated with survival and did not show a bimodal pattern that would support the presence of two phenotypes. In the multivariable model, protective ventilation (aHR 0.73 [95%CI 0.57-0.94]), adjusted for PF ratio, compliance, PEEP, and arterial pH, was independently associated with survival.

CONCLUSIONS:

During the peak of the epidemic in Sao Paulo, critically ill patients with COVID-19 often required mechanical ventilation and mortality was high. Our findings revealed an association between mechanical ventilation strategy and mortality, highlighting the importance of protective ventilation for patients with COVID-19.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: Ann Intensive Care Year: 2021 Document Type: Article Affiliation country: S13613-021-00882-w

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: Ann Intensive Care Year: 2021 Document Type: Article Affiliation country: S13613-021-00882-w