Observational study of changes in utilization and outcomes in mechanical ventilation in COVID-19.

BACKGROUND

The role of non-invasive ventilation (NIV) in severe COVID-19 remains a matter of debate. Therefore, the utilization and outcome of NIV in COVID-19 in an unbiased cohort was determined.

AIM

The aim was to provide a detailed account of hospitalized COVID-19 patients requiring non-invasive ventilation during their hospital stay. Furthermore, differences of patients treated with NIV between the first and second wave are explored.

METHODS

Confirmed COVID-19 cases of claims data of the Local Health Care Funds with non-invasive and/or invasive mechanical ventilation (MV) in the spring and autumn pandemic period in 2020 were comparable analysed.

RESULTS

Nationwide cohort of 17.023 cases (median/IQR age 71/61-80 years, 64% male) 7235 (42.5%) patients primarily received IMV without NIV, 4469 (26.3%) patients received NIV without subsequent intubation, and 3472 (20.4%) patients had NIV failure (NIV-F), defined by subsequent endotracheal intubation. The proportion of patients who received invasive MV decreased from 75% to 37% during the second period. Accordingly, the proportion of patients with NIV exclusively increased from 9% to 30%, and those failing NIV increased from 9% to 23%. Median length of hospital stay decreased from 26 to 21 days, and duration of MV decreased from 11.9 to 7.3 days. The NIV failure rate decreased from 49% to 43%. Overall mortality increased from 51% versus 54%. Mortality was 44% with NIV-only, 54% with IMV and 66% with NIV-F with mortality rates steadily increasing from 62% in early NIV-F (day 1) to 72% in late NIV-F (>4 days).

CONCLUSIONS

Utilization of NIV rapidly increased during the autumn period, which was associated with a reduced duration of MV, but not with overall mortality. High NIV-F rates are associated with increased mortality, particularly in late NIV-F.

Déclaration de conflit d'intérêts

Dr. Karagiannidis reports personal fees from Maquet, personal fees from Xenios, personal fees from Bayer, non-financial support from Speaker of the German register of ICUs, grants from German Ministry of Research and Education, during the conduct of the study. Dr. Hentschker has nothing to disclose. Dr. Westhoff has nothing to disclose. Dr. Weber-Carstens has nothing to disclose. Dr. Janssens has nothing to disclose. Dr. Kluge reports non-financial support from Ambu, ETView Ltd, Fisher & Paykel and Xenios., grants from Daiichi Sankyo, Pfizer, personal fees from Astra, C.R. Bard, Baxter, Biotest, Cytosorbents, Fresenius, Gilead, MSD, Pfizer, Philips, ZOLL, personal fees and other from Bayer, Fresenius, Gilead, MSD und Pfizer, outside the submitted work. MP reports no conflicts of interests in regard to the manuscript, lecture fees from Boehringer, Novartis, Astra_Zeneca, Roche and fees for advisory board meetings from Boehringer, Novartis, Roche Current president of the German Society of Pneumology. Dr. Spies reports grants from Public Grants, grants from IIT grants from companies, other from Meeting support from companies (e.g. for the Leopoldina 2020 meeting), outside the submitted work; In addition, Dr. Spies has a patent EEG monitoring licensed, and a patent Ceilings licensed. Dr. Welte reports grants from German Minstry of Research and Education, during the conduct of the study. This does not alter our adherence to PLOS ONE policies on sharing data and materials.