Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs.
ARDS
Coronavirus disease 2019
Intensive care
Mechanical ventilation
Outcomes, mortality
Respiration, artificial
Journal
Journal of intensive care
ISSN: 2052-0492
Titre abrégé: J Intensive Care
Pays: England
ID NLM: 101627304
Informations de publication
Date de publication:
2020
2020
Historique:
received:
30
07
2020
accepted:
07
10
2020
entrez:
20
10
2020
pubmed:
21
10
2020
medline:
21
10
2020
Statut:
epublish
Résumé
A large proportion of patients with coronavirus disease 2019 (COVID-19) develop severe respiratory failure requiring admission to the intensive care unit (ICU) and about 80% of them need mechanical ventilation (MV). These patients show great complexity due to multiple organ involvement and a dynamic evolution over time; moreover, few information is available about the risk factors that may contribute to increase the time course of mechanical ventilation.The primary objective of this study is to investigate the risk factors associated with the inability to liberate COVID-19 patients from mechanical ventilation. Due to the complex evolution of the disease, we analyzed both pulmonary variables and occurrence of non-pulmonary complications during mechanical ventilation. The secondary objective of this study was the evaluation of risk factors for ICU mortality. This multicenter prospective observational study enrolled 391 patients from fifteen COVID-19 dedicated Italian ICUs which underwent invasive mechanical ventilation for COVID-19 pneumonia. Clinical and laboratory data, ventilator parameters, occurrence of organ dysfunction, and outcome were recorded. The primary outcome measure was 28 days ventilator-free days and the liberation from MV at 28 days was studied by performing a competing risks regression model on data, according to the method of Fine and Gray; the event death was considered as a competing risk. Liberation from mechanical ventilation was achieved in 53.2% of the patients (208/391). Competing risks analysis, considering death as a competing event, demonstrated a decreased sub-hazard ratio for liberation from mechanical ventilation (MV) with increasing age and SOFA score at ICU admission, low values of PaO Age, SOFA score at ICU admission, C NCT04411459.
Sections du résumé
BACKGROUND
BACKGROUND
A large proportion of patients with coronavirus disease 2019 (COVID-19) develop severe respiratory failure requiring admission to the intensive care unit (ICU) and about 80% of them need mechanical ventilation (MV). These patients show great complexity due to multiple organ involvement and a dynamic evolution over time; moreover, few information is available about the risk factors that may contribute to increase the time course of mechanical ventilation.The primary objective of this study is to investigate the risk factors associated with the inability to liberate COVID-19 patients from mechanical ventilation. Due to the complex evolution of the disease, we analyzed both pulmonary variables and occurrence of non-pulmonary complications during mechanical ventilation. The secondary objective of this study was the evaluation of risk factors for ICU mortality.
METHODS
METHODS
This multicenter prospective observational study enrolled 391 patients from fifteen COVID-19 dedicated Italian ICUs which underwent invasive mechanical ventilation for COVID-19 pneumonia. Clinical and laboratory data, ventilator parameters, occurrence of organ dysfunction, and outcome were recorded. The primary outcome measure was 28 days ventilator-free days and the liberation from MV at 28 days was studied by performing a competing risks regression model on data, according to the method of Fine and Gray; the event death was considered as a competing risk.
RESULTS
RESULTS
Liberation from mechanical ventilation was achieved in 53.2% of the patients (208/391). Competing risks analysis, considering death as a competing event, demonstrated a decreased sub-hazard ratio for liberation from mechanical ventilation (MV) with increasing age and SOFA score at ICU admission, low values of PaO
CONCLUSIONS
CONCLUSIONS
Age, SOFA score at ICU admission, C
TRIAL REGISTRATION
BACKGROUND
NCT04411459.
Identifiants
pubmed: 33078076
doi: 10.1186/s40560-020-00499-4
pii: 499
pmc: PMC7558552
doi:
Banques de données
ClinicalTrials.gov
['NCT04411459']
Types de publication
Journal Article
Langues
eng
Pagination
80Investigateurs
Marco Tartaglione
(M)
Valentina Chiarini
(V)
Virginia Buldini
(V)
Carlo Coniglio
(C)
Federico Moro
(F)
Nicola Cilloni
(N)
Lorenzo Giuntoli
(L)
Angela Bellocchio
(A)
Emanuele Matteo
(E)
Giacinto Pizzilli
(G)
Antonio Siniscalchi
(A)
Chiara Tartivita
(C)
Francesco Matteo
(F)
Annalisa Marchio
(A)
Igor Bacchilega
(I)
Laura Bernabé
(L)
Sonia Guarino
(S)
Giulia Mosconi
(G)
Luca Bissoni
(L)
Lorenzo Viola
(L)
Tommaso Meconi
(T)
Vittorio Pavoni
(V)
Aline Pagni
(A)
Patrizia Pompa Cleta
(P)
Marco Cavagnino
(M)
Anna Malfatto
(A)
Angelina Adduci
(A)
Silvia Pareschi
(S)
Gabriele Melegari
(G)
Jessica Maccieri
(J)
Elisa Marinangeli
(E)
Fabrizio Racca
(F)
Marco Verri
(M)
Giulia Falò
(G)
Elisabetta Marangoni
(E)
Francesco Boni
(F)
Giulia Felloni
(G)
Federico Domenico Baccarini
(FD)
Marina Terzitta
(M)
Stefano Maitan
(S)
Michele Imbriani
(M)
Paolo Orlandi
(P)
Giorgia Dalpiaz
(G)
Rita Golfieri
(R)
Federica Ciccarese
(F)
Antonio Poerio
(A)
Francesco Muratore
(F)
Fabio Ferrari
(F)
Martina Mughetti
(M)
Loredana Franchini
(L)
Ersenad Neziri
(E)
Marco Miceli
(M)
Maria Teresa Minguzzi
(MT)
Lorenzo Mellini
(L)
Sara Piciucchi
(S)
Commentaires et corrections
Type : ErratumIn
Informations de copyright
© The Author(s) 2020.
Déclaration de conflit d'intérêts
Competing interestsThe authors have no conflict of interest to declare.
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