Association of intensity of ventilation with 28-day mortality in COVID-19 patients with acute respiratory failure: insights from the PRoVENT-COVID study.
Acute respiratory failure
COVID-19
Coronavirus disease 2019
Driving pressure
ICU
Invasive ventilation
Mechanical power
Mechanical power of ventilation
Mortality
ΔP
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
06 08 2021
06 08 2021
Historique:
received:
08
06
2021
accepted:
28
07
2021
entrez:
7
8
2021
pubmed:
8
8
2021
medline:
19
8
2021
Statut:
epublish
Résumé
The intensity of ventilation, reflected by driving pressure (ΔP) and mechanical power (MP), has an association with outcome in invasively ventilated patients with or without acute respiratory distress syndrome (ARDS). It is uncertain if a similar association exists in coronavirus disease 2019 (COVID-19) patients with acute respiratory failure. We aimed to investigate the impact of intensity of ventilation on patient outcome. The PRoVENT-COVID study is a national multicenter observational study in COVID-19 patients receiving invasive ventilation. Ventilator parameters were collected a fixed time points on the first calendar day of invasive ventilation. Mean dynamic ΔP and MP were calculated for individual patients at time points without evidence of spontaneous breathing. A Cox proportional hazard model, and a double stratification analysis adjusted for confounders were used to estimate the independent associations of ΔP and MP with outcome. The primary endpoint was 28-day mortality. In 825 patients included in this analysis, 28-day mortality was 27.5%. ΔP was not independently associated with mortality (HR 1.02 [95% confidence interval 0.88-1.18]; P = 0.750). MP, however, was independently associated with 28-day mortality (HR 1.17 [95% CI 1.01-1.36]; P = 0.031), and increasing quartiles of MP, stratified on comparable levels of ΔP, had higher risks of 28-day mortality (HR 1.15 [95% CI 1.01-1.30]; P = 0.028). In this cohort of critically ill invasively ventilated COVID-19 patients with acute respiratory failure, we show an independent association of MP, but not ΔP with 28-day mortality. MP could serve as one prognostic biomarker in addition to ΔP in these patients. Efforts aiming at limiting both ΔP and MP could translate in a better outcome. Trial registration Clinicaltrials.gov (study identifier NCT04346342).
Sections du résumé
BACKGROUND
The intensity of ventilation, reflected by driving pressure (ΔP) and mechanical power (MP), has an association with outcome in invasively ventilated patients with or without acute respiratory distress syndrome (ARDS). It is uncertain if a similar association exists in coronavirus disease 2019 (COVID-19) patients with acute respiratory failure.
METHODS
We aimed to investigate the impact of intensity of ventilation on patient outcome. The PRoVENT-COVID study is a national multicenter observational study in COVID-19 patients receiving invasive ventilation. Ventilator parameters were collected a fixed time points on the first calendar day of invasive ventilation. Mean dynamic ΔP and MP were calculated for individual patients at time points without evidence of spontaneous breathing. A Cox proportional hazard model, and a double stratification analysis adjusted for confounders were used to estimate the independent associations of ΔP and MP with outcome. The primary endpoint was 28-day mortality.
RESULTS
In 825 patients included in this analysis, 28-day mortality was 27.5%. ΔP was not independently associated with mortality (HR 1.02 [95% confidence interval 0.88-1.18]; P = 0.750). MP, however, was independently associated with 28-day mortality (HR 1.17 [95% CI 1.01-1.36]; P = 0.031), and increasing quartiles of MP, stratified on comparable levels of ΔP, had higher risks of 28-day mortality (HR 1.15 [95% CI 1.01-1.30]; P = 0.028).
CONCLUSIONS
In this cohort of critically ill invasively ventilated COVID-19 patients with acute respiratory failure, we show an independent association of MP, but not ΔP with 28-day mortality. MP could serve as one prognostic biomarker in addition to ΔP in these patients. Efforts aiming at limiting both ΔP and MP could translate in a better outcome. Trial registration Clinicaltrials.gov (study identifier NCT04346342).
Identifiants
pubmed: 34362415
doi: 10.1186/s13054-021-03710-6
pii: 10.1186/s13054-021-03710-6
pmc: PMC8343355
doi:
Banques de données
ClinicalTrials.gov
['NCT04346342']
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
283Investigateurs
J P van Akkeren
(JP)
A G Algera
(AG)
C K Algoe
(CK)
R B van Amstel
(RB)
O L Baur
(OL)
P van de Berg
(P)
D C J J Bergmans
(DCJJ)
D I van den Bersselaar
(DI)
F A Bertens
(FA)
A J G H Bindels
(AJGH)
M M de Boer
(MM)
S den Boer
(SD)
L S Boers
(LS)
M Bogerd
(M)
L D J Bos
(LDJ)
M Botta
(M)
J S Breel
(JS)
H de Bruin
(H)
S de Bruin
(S)
C L Bruna
(CL)
L A Buiteman-Kruizinga
(LA)
O Cremer
(O)
R M Determann
(RM)
W Dieperink
(W)
D A Dongelmans
(DA)
H S Franke
(HS)
M S Galek Aldridge
(MSG)
M J de Graaff
(MJ)
L A Hagens
(LA)
J J Haringman
(JJ)
N F L Heijnen
(NFL)
S Hiel
(S)
S T van der Heide
(ST)
P L J van der Heiden
(PLJ)
L L Hoeijmakers
(LL)
L Hol
(L)
M W Hollmann
(MW)
M E Hoogendoorn
(ME)
J Horn
(J)
R van der Horst
(R)
E L K Ie
(ELK)
D Ivanov
(D)
N P Juffermans
(NP)
E Kho
(E)
E S de Klerk
(ES)
A W M Koopman
(AWM)
M Koopmans
(M)
S Kucukcelebi
(S)
M A Kuiper
(MA)
D W de Lange
(DW)
D M van Meenen
(DM)
Ignacio Martin-Loeches
(I)
Guido Mazzinari
(G)
N van Mourik
(N)
S G Nijbroek
(SG)
M Onrust
(M)
E A N Oostdijk
(EAN)
F Paulus
(F)
C J Pennartz
(CJ)
J Pillay
(J)
L Pisani
(L)
I M Purmer
(IM)
T C D Rettig
(TCD)
J P Roozeman
(JP)
M T U Schuijt
(MTU)
M J Schultz
(MJ)
A Serpa Neto
(AS)
M E Sleeswijk
(ME)
M R Smit
(MR)
P E Spronk
(PE)
W Stilma
(W)
A C Strang
(AC)
A M Tsonas
(AM)
P R Tuinman
(PR)
C M A Valk
(CMA)
F L Veen
(FL)
A P J Vlaar
(APJ)
L I Veldhuis
(LI)
P van Velzen
(P)
W H van der Ven
(WH)
P van Vliet
(P)
P van der Voort
(P)
H H van der Wier
(HH)
L van Welie
(L)
H J F T Wesselink
(HJFT)
B van Wijk
(B)
T Winters
(T)
W Y Wong
(WY)
A R H van Zanten
(ARH)
Informations de copyright
© 2021. The Author(s).
Références
Rev Esp Anestesiol Reanim (Engl Ed). 2020 Oct;67(8):425-437
pubmed: 32800622
Ann Am Thorac Soc. 2019 Oct;16(10):1263-1272
pubmed: 31247145
Lancet Respir Med. 2020 Dec;8(12):1201-1208
pubmed: 32861276
Intensive Care Med. 2016 Oct;42(10):1567-1575
pubmed: 27620287
Intensive Care Med. 2020 Nov;46(11):2035-2047
pubmed: 33034689
Intensive Care Med. 2021 Jan;47(1):60-73
pubmed: 33211135
J Epidemiol Glob Health. 2021 Mar;11(1):98-104
pubmed: 33095982
Lancet Respir Med. 2020 Sep;8(9):905-913
pubmed: 32735841
Ann Transl Med. 2018 Oct;6(19):395
pubmed: 30460269
EClinicalMedicine. 2020 Aug;25:100449
pubmed: 32838231
JAMA Intern Med. 2020 Oct 1;180(10):1345-1355
pubmed: 32667669
Intensive Care Med. 2019 Jun;45(6):856-864
pubmed: 31062050
Intensive Care Med. 2018 Nov;44(11):1914-1922
pubmed: 30291378
JAMA. 2020 May 26;323(20):2052-2059
pubmed: 32320003
Intensive Care Med Exp. 2019 Nov 27;7(1):61
pubmed: 31773328
Am J Respir Crit Care Med. 2021 Jan 1;203(1):54-66
pubmed: 33119402
Clin Interv Aging. 2020 Nov 09;15:2095-2107
pubmed: 33204075
Intensive Care Med. 2020 Dec;46(12):2200-2211
pubmed: 32728965
Crit Care. 2017 Jul 12;21(1):183
pubmed: 28701178
Crit Care. 2020 Jul 11;24(1):417
pubmed: 32653011
Intensive Care Med. 2020 Oct;46(10):1941-1943
pubmed: 32504104
Ann Transl Med. 2020 Oct;8(19):1251
pubmed: 33178783
Crit Care Med. 2013 Apr;41(4):1046-55
pubmed: 23385096
Lancet Respir Med. 2021 Feb;9(2):139-148
pubmed: 33169671
Crit Care Med. 2021 Mar 1;49(3):437-448
pubmed: 33555777
Lancet. 2020 Jun 6;395(10239):1763-1770
pubmed: 32442528
N Engl J Med. 2015 Feb 19;372(8):747-55
pubmed: 25693014
Crit Care. 2020 May 24;24(1):246
pubmed: 32448389
Intensive Care Med. 2019 Sep;45(9):1321-1323
pubmed: 31101961