Clinical characteristics and outcomes of invasively ventilated patients with COVID-19 in Argentina (SATICOVID): a prospective, multicentre cohort study.

Adult Aged Argentina / epidemiology COVID-19 / complications COVID-19 Nucleic Acid Testing Female Hospital Mortality Humans Intensive Care Units / statistics & numerical data Intubation, Intratracheal / statistics & numerical data Male Middle Aged Prospective Studies Respiration, Artificial / methods Respiratory Insufficiency / diagnosis Risk Factors SARS-CoV-2 / isolation & purification Tidal Volume Treatment Outcome Young Adult

Journal

The Lancet. Respiratory medicine

ISSN: 2213-2619

Titre abrégé: Lancet Respir Med

Pays: England

ID NLM: 101605555

Informations de publication

Date de publication:
09 2021

Historique:

received: 18 02 2021

revised: 01 05 2021

accepted: 06 05 2021

pubmed: 6 7 2021

medline: 15 9 2021

entrez: 5 7 2021

Statut: ppublish

Résumé

Although COVID-19 has greatly affected many low-income and middle-income countries, detailed information about patients admitted to the intensive care unit (ICU) is still scarce. Our aim was to examine ventilation characteristics and outcomes in invasively ventilated patients with COVID-19 in Argentina, an upper middle-income country. In this prospective, multicentre cohort study (SATICOVID), we enrolled patients aged 18 years or older with RT-PCR-confirmed COVID-19 who were on invasive mechanical ventilation and admitted to one of 63 ICUs in Argentina. Patient demographics and clinical, laboratory, and general management variables were collected on day 1 (ICU admission); physiological respiratory and ventilation variables were collected on days 1, 3, and 7. The primary outcome was all-cause in-hospital mortality. All patients were followed until death in hospital or hospital discharge, whichever occurred first. Secondary outcomes were ICU mortality, identification of independent predictors of mortality, duration of invasive mechanical ventilation, and patterns of change in physiological respiratory and mechanical ventilation variables. The study is registered with ClinicalTrials.gov, NCT04611269, and is complete. Between March 20, 2020, and Oct 31, 2020, we enrolled 1909 invasively ventilated patients with COVID-19, with a median age of 62 years [IQR 52-70]. 1294 (67·8%) were men, hypertension and obesity were the main comorbidities, and 939 (49·2%) patients required vasopressors. Lung-protective ventilation was widely used and median duration of ventilation was 13 days (IQR 7-22). Median tidal volume was 6·1 mL/kg predicted bodyweight (IQR 6·0-7·0) on day 1, and the value increased significantly up to day 7; positive end-expiratory pressure was 10 cm H In patients with COVID-19 who required invasive mechanical ventilation, lung-protective ventilation was widely used but mortality was high. Predictors of mortality in our study broadly agreed with those identified in studies of invasively ventilated patients in high-income countries. The sustained burden of COVID-19 on scarce health-care personnel might have contributed to high mortality over the course of our study in Argentina. These data might help to identify points for improvement in the management of patients in middle-income countries and elsewhere. None. For the Spanish translation of the Summary see Supplementary Materials section.

Sections du résumé

BACKGROUND

METHODS

In this prospective, multicentre cohort study (SATICOVID), we enrolled patients aged 18 years or older with RT-PCR-confirmed COVID-19 who were on invasive mechanical ventilation and admitted to one of 63 ICUs in Argentina. Patient demographics and clinical, laboratory, and general management variables were collected on day 1 (ICU admission); physiological respiratory and ventilation variables were collected on days 1, 3, and 7. The primary outcome was all-cause in-hospital mortality. All patients were followed until death in hospital or hospital discharge, whichever occurred first. Secondary outcomes were ICU mortality, identification of independent predictors of mortality, duration of invasive mechanical ventilation, and patterns of change in physiological respiratory and mechanical ventilation variables. The study is registered with ClinicalTrials.gov, NCT04611269, and is complete.

FINDINGS

Between March 20, 2020, and Oct 31, 2020, we enrolled 1909 invasively ventilated patients with COVID-19, with a median age of 62 years [IQR 52-70]. 1294 (67·8%) were men, hypertension and obesity were the main comorbidities, and 939 (49·2%) patients required vasopressors. Lung-protective ventilation was widely used and median duration of ventilation was 13 days (IQR 7-22). Median tidal volume was 6·1 mL/kg predicted bodyweight (IQR 6·0-7·0) on day 1, and the value increased significantly up to day 7; positive end-expiratory pressure was 10 cm H

INTERPRETATION

In patients with COVID-19 who required invasive mechanical ventilation, lung-protective ventilation was widely used but mortality was high. Predictors of mortality in our study broadly agreed with those identified in studies of invasively ventilated patients in high-income countries. The sustained burden of COVID-19 on scarce health-care personnel might have contributed to high mortality over the course of our study in Argentina. These data might help to identify points for improvement in the management of patients in middle-income countries and elsewhere.

FUNDING

None.

TRANSLATION

For the Spanish translation of the Summary see Supplementary Materials section.

Identifiants

DOI: 10.1016/S2213-2600(21)00229-0 PMID: 34224674 PMC: PMC8253540

pubmed: 34224674

pii: S2213-2600(21)00229-0

doi: 10.1016/S2213-2600(21)00229-0

pmc: PMC8253540

pii:

doi:

Banques de données

ClinicalTrials.gov

['NCT04611269']

Types de publication

Journal Article Multicenter Study Observational Study

Langues

eng

Sous-ensembles de citation

Pagination

989-998

Investigateurs

E Estenssoro (E)

A Dubin (A)

C I Loudet (CI)

F Ríos (F)

V S Kanoore Edul (VS)

G Plotnikow (G)

R Reina (R)

M Andrian (M)

J Ivacachi (J)

I Romero (I)

C Garay (C)

D Piezny (D)

J Sagardía (J)

M Bezzi (M)

S Borello (S)

V Mandich (V)

D Chiacchiara (D)

C Groer (C)

C García Almirón (C)

A Kovac (A)

S Torres (S)

C Cesio (C)

C Orlandi (C)

R Hernández (R)

P N Rubatto Birri (PN)

M Mugno (M)

M F Valenti (MF)

R A Gómez (RA)

E Cunto (E)

V Chediack (V)

M G Sáenz (MG)

C Marchena (C)

N Tiribelli (N)

M Guaymas (M)

V Aphalo (V)

D Vázquez (D)

Y Saad (Y)

D Sánchez (D)

F Iglesias (F)

P Casteluccio (P)

B Lattanzio (B)

S Eiguren (S)

D Noval (D)

S Fredes (S)

G C Izzo (GC)

H Cabrera (H)

M O Pozo (MO)

S Sac (S)

N Tornatore (N)

J Sakugawa (J)

C Villafañe (C)

A Di Sibio (A)

P Maskin (P)

P Rodríguez (P)

N Nihany (N)

M Mogadouro (M)

F Pálizas H (F)

E Cornú (E)

M Esperatti (M)

J M Pintos (JM)

G Badariotti (G)

G Echevarría (G)

A M Mazzola (AM)

C Giuggia (C)

N Dargains (N)

A Turano (A)

F Pugliese (F)

M J Zec Baskarad (MJ)

M Chamadoira (M)

J C Medina (JC)

M Búsico (M)

F Villarejo (F)

H Collazos (H)

T Huanca (T)

J C Pendino (JC)

L Talamonti (L)

F Skrzypiec (F)

C Tascón (C)

G Genovese (G)

H Alul (H)

A Zavattieri (A)

A J Herrera (AJ)

N Rosales (N)

M G Quintana (MG)

A Risso Vazquez (A)

M Lugaro (M)

E Díaz Rousseaux (E)

M Falcone (M)

F Kurban (F)

M Cini (M)

G Zakalik (G)

C Pellegrini (C)

G Fernández (G)

J P Sottile (JP)

S Barrios (S)

O Hamada (O)

V Mendiluce (V)

D Villalba (D)

F Sacco (F)

V Mezzina (V)

C Servin (C)

M Quinteros (M)

H Nuñez (H)

M L Campassi (ML)

D Banegas (D)

C Balasini (C)

V Leiva (V)

F Maicol (F)

G Domeniconi (G)

V Vilaseca (V)

A Barrientos (A)

F Larocca (F)

L Kumar (L)

R Luna (R)

M Deheza Lonardi (M)

A Oholeguy (A)

J Carnero Echegaray (J)

C Marazzi (C)

P Helca Regis (P)

F Rópolo (F)

A Bobadilla (A)

V Thomas (V)

N Funes Nelson (N)

C Villavicencio (C)

P Machare (P)

N Aramayo (N)

C González (C)

M Ferriccioni (M)

J Bergesio (J)

Commentaires et corrections

Type : CommentIn

Informations de copyright

Déclaration de conflit d'intérêts

Declaration of interests The authors declare no competing interests.