Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort.
ARDS
COVID-19
High flow oxygen therapy
Invasive mechanical ventilation
Noninvasive mechanical ventilation
Patient self-inflicted lung injury
Respiratory support
Standard oxygen therapy
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
25 05 2021
25 05 2021
Historique:
received:
10
02
2021
accepted:
15
04
2021
entrez:
26
5
2021
pubmed:
27
5
2021
medline:
2
6
2021
Statut:
epublish
Résumé
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. 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 34034782
doi: 10.1186/s13054-021-03580-y
pii: 10.1186/s13054-021-03580-y
pmc: PMC8146172
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
175Investigateurs
Pedro D Wendel Garcia
(PD)
Hernán Aguirre-Bermeo
(H)
Philipp K Buehler
(PK)
Mario Alfaro-Farias
(M)
Bernd Yuen
(B)
Sascha David
(S)
Thomas Tschoellitsch
(T)
Tobias Wengenmayer
(T)
Anita Korsos
(A)
Alberto Fogagnolo
(A)
Gian-Reto Kleger
(GR)
Maddalena A Wu
(MA)
Riccardo Colombo
(R)
Fabrizio Turrini
(F)
Antonella Potalivo
(A)
Emanuele Rezoagli
(E)
Raquel Rodríguez-García
(R)
Pedro Castro
(P)
Arantxa Lander-Azcona
(A)
Maria C Martín-Delgado
(MC)
Herminia Lozano-Gómez
(H)
Rolf Ensner
(R)
Marc P Michot
(MP)
Nadine Gehring
(N)
Peter Schott
(P)
Martin Siegemund
(M)
Lukas Merki
(L)
Jan Wiegand
(J)
Marie M Jeitziner
(MM)
Marcus Laube
(M)
Petra Salomon
(P)
Frank Hillgaertner
(F)
Alexander Dullenkopf
(A)
Hatem Ksouri
(H)
Sara Cereghetti
(S)
Serge Grazioli
(S)
Christian Bürkle
(C)
Julien Marrel
(J)
Isabelle Fleisch
(I)
Marie-Helene Perez
(MH)
Anja Baltussen Weber
(A)
Samuele Ceruti
(S)
Katharina Marquardt
(K)
Tobias Hübner
(T)
Hermann Redecker
(H)
Michael Studhalter
(M)
Michael Stephan
(M)
Daniela Selz
(D)
Urs Pietsch
(U)
Anette Ristic
(A)
Antje Heise
(A)
Friederike Meyer Zu Bentrup
(F)
Marilene Franchitti Laurent
(M)
Patricia Fodor
(P)
Tomislav Gaspert
(T)
Christoph Haberthuer
(C)
Elif Colak
(E)
Dorothea M Heuberger
(DM)
Thierry Fumeaux
(T)
Jonathan Montomoli
(J)
Philippe Guerci
(P)
Reto A Schuepbach
(RA)
Matthias P Hilty
(MP)
Ferran Roche-Campo
(F)
Angela Algaba-Calderon
(A)
Janina Apolo
(J)
Theodoros Aslanidis
(T)
Barna Babik
(B)
Filippo Boroli
(F)
Jan Brem
(J)
Mirko Brenni
(M)
Silvio D Brugger
(SD)
Giovanni Camen
(G)
Emanuele Catena
(E)
Roberto Ceriani
(R)
Ivan Chau
(I)
Andreas Christ
(A)
Chiara Cogliati
(C)
Pablo Concha
(P)
Gauthier Delahaye
(G)
Iris Drvaric
(I)
Jesús Escós-Orta
(J)
Silvia Fabbri
(S)
Francesca Facondini
(F)
Miodrag Filipovic
(M)
Jorge Gámez-Zapata
(J)
Peter Gerecke
(P)
Diederik Gommers
(D)
Thomas Hillermann
(T)
Can Ince
(C)
Beatrice Jenni-Moser
(B)
Marija Jovic
(M)
Geoffrey Jurkolow
(G)
Alexander Klarer
(A)
Adriana Lambert
(A)
Jean-Christophe Laurent
(JC)
Jerome Lavanchy
(J)
Barbara Lienhardt-Nobbe
(B)
Pascal Locher
(P)
Marie-Reine Losser
(MR)
Roger F Lussman
(RF)
Aurora Magliocca
(A)
Antoni Margarit
(A)
Alberto Martínez
(A)
Romano Mauri
(R)
Eric Mayor-Vázquez
(E)
Jens Meier
(J)
Mallory Moret-Bochatay
(M)
Martina Murrone
(M)
Didier Naon
(D)
Thomas Neff
(T)
Emmanuel Novy
(E)
Lina Petersen
(L)
Jerome Pugin
(J)
Anne-Sylvie Ramelet
(AS)
Jonathan Rilinger
(J)
Peter C Rimensberger
(PC)
Michael Sepulcri
(M)
Karim Shaikh
(K)
Marianne Sieber
(M)
Maria Sole Simonini
(MS)
Savino Spadaro
(S)
Govind Oliver Sridharan
(GO)
Klaus Stahl
(K)
Dawid L Staudacher
(DL)
Xiana Taboada-Fraga
(X)
Adrian Tellez
(A)
Severin Urech
(S)
Giovanni Vitale
(G)
Gerardo Vizmanos-Lamotte
(G)
Tobias Welte
(T)
Begoña Zalba-Etayo
(B)
Nuria Zellweger
(N)
Références
Crit Care Med. 2021 Feb 1;49(2):209-214
pubmed: 33105150
Chest. 2020 Dec;158(6):2275-2277
pubmed: 32707184
Crit Care Med. 2012 May;40(5):1578-85
pubmed: 22430241
Ann Intensive Care. 2020 Nov 18;10(1):156
pubmed: 33206244
Intensive Care Med. 2020 Dec;46(12):2238-2247
pubmed: 32901374
Am J Respir Crit Care Med. 2019 Jun 1;199(11):1368-1376
pubmed: 30576221
Am J Respir Crit Care Med. 2017 Jan 1;195(1):67-77
pubmed: 27753501
Intensive Care Med. 2015 Apr;41(4):623-32
pubmed: 25691263
J Clin Epidemiol. 2001 Apr;54(4):387-98
pubmed: 11297888
BMC Pulm Med. 2014 Feb 13;14:19
pubmed: 24520952
Ann Intensive Care. 2020 Oct 12;10(1):134
pubmed: 33044591
Crit Care Med. 2016 Jan;44(1):120-9
pubmed: 26474112
Intensive Care Med. 2017 Feb;43(2):192-199
pubmed: 27812731
Intensive Care Med. 2020 Oct;46(10):1924-1926
pubmed: 32671470
Intensive Care Med. 2021 Jan;47(1):60-73
pubmed: 33211135
Chest. 2020 Sep;158(3):1046-1049
pubmed: 32247712
Intensive Care Med. 2020 Dec;46(12):2226-2237
pubmed: 33201321
Chest. 2016 Nov;150(5):1109-1117
pubmed: 27477213
Anesth Analg. 2020 Aug;131(2):e114-e115
pubmed: 32366771
J Intensive Care Med. 2020 Oct 29;:885066620968041
pubmed: 33118405
JAMA. 2009 Nov 4;302(17):1872-9
pubmed: 19822627
Crit Care Med. 2017 Jul;45(7):e727-e733
pubmed: 28441237
Chest. 2021 Feb;159(2):653-656
pubmed: 32882246
JAMA. 2020 Jul 7;324(1):57-67
pubmed: 32496521
Lancet Respir Med. 2021 Feb;9(2):139-148
pubmed: 33169671
Chest. 2020 Nov;158(5):1992-2002
pubmed: 32681847
Crit Care Med. 2020 Jun;48(6):e440-e469
pubmed: 32224769
Crit Care Med. 2006 Nov;34(11):2749-57
pubmed: 16932229
Ann Intensive Care. 2020 Jul 8;10(1):88
pubmed: 32642804
Lancet. 2020 Jun 6;395(10239):1763-1770
pubmed: 32442528
Am J Respir Crit Care Med. 2017 Feb 15;195(4):438-442
pubmed: 27626833
Crit Care Med. 2008 Feb;36(2):441-7
pubmed: 18091540
N Engl J Med. 2015 Jun 4;372(23):2185-96
pubmed: 25981908
Ann Intensive Care. 2015 Mar 06;5:4
pubmed: 25852964
Ann Transl Med. 2017 Jul;5(14):297
pubmed: 28828372
Eur Respir J. 2017 Aug 31;50(2):
pubmed: 28860265
JAMA. 2020 Jun 9;323(22):2329-2330
pubmed: 32329799
Crit Care Explor. 2020 Oct 21;2(10):e0254
pubmed: 33134945
Ann Am Thorac Soc. 2021 May;18(5):917-918
pubmed: 33357147
Ann Intensive Care. 2020 Jun 9;10(1):78
pubmed: 32519064
Am J Respir Crit Care Med. 2020 Oct 1;202(7):1039-1042
pubmed: 32758000
Ann Intensive Care. 2020 Aug 3;10(1):105
pubmed: 32748116
Crit Care Med. 2016 Feb;44(2):282-90
pubmed: 26584191
Ann Am Thorac Soc. 2021 May;18(5):916-917
pubmed: 33357148
EClinicalMedicine. 2020 Aug;25:100449
pubmed: 32838231
EClinicalMedicine. 2020 Nov;28:100570
pubmed: 33043285
Lancet Respir Med. 2020 Sep;8(9):853-862
pubmed: 32735842