Association of ventilator type with hospital mortality in critically ill patients with SARS-CoV2 infection: a prospective study.
COVID-19
ICU
Mortality
Outcomes
Ventilator
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
08 Feb 2022
08 Feb 2022
Historique:
received:
01
10
2021
accepted:
13
01
2022
entrez:
8
2
2022
pubmed:
9
2
2022
medline:
9
2
2022
Statut:
epublish
Résumé
To evaluate the association between ventilator type and hospital mortality in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (SARS-CoV2 infection), a single-center prospective observational study in France. We prospectively included consecutive adults admitted to the intensive care unit (ICU) of a university-affiliated tertiary hospital for ARDS related to proven COVID-19, between March 2020 and July 2021. All patients were intubated. We compared two patient groups defined by whether an ICU ventilator or a less sophisticated ventilator such as a sophisticated turbine-based transport ventilator was used. Kaplan-Meier survival curves were plotted. Cox multivariate regression was performed to identify associations between patient characteristics and hospital mortality. We included 189 patients (140 [74.1%] men) with a median age of 65 years [IQR, 55-73], of whom 61 (32.3%) died before hospital discharge. By multivariate analysis, factors associated with in-hospital mortality were age ≥ 70 years (HR, 2.11; 95% CI, 1.24-3.59; P = 0.006), immunodeficiency (HR, 2.43; 95% CI, 1.16-5.09; P = 0.02) and serum creatinine ≥ 100 µmol/L (HR, 3.01; 95% CI, 1.77-5.10; P < 0.001) but not ventilator type. As compared to conventional ICU (equipped with ICU and anesthesiology ventilators), management in transient ICU (equipped with non-ICU turbine-based ventilators) was associated neither with a longer duration of invasive mechanical ventilation (18 [IQR, 11-32] vs. 21 [13-37] days, respectively; P = 0.39) nor with a longer ICU stay (24 [IQR, 14-40] vs. 27 [15-44] days, respectively; P = 0.44). In ventilated patients with ARDS due to COVID-19, management in transient ICU equipped with non-ICU sophisticated turbine-based ventilators was not associated with worse outcomes compared to standard ICU, equipped with ICU ventilators. Although our study design is not powered to demonstrate any difference in outcome, our results after adjustment do not suggest any signal of harm when using these transport type ventilators as an alternative to ICU ventilators during COVID-19 surge.
Sections du résumé
BACKGROUND
BACKGROUND
To evaluate the association between ventilator type and hospital mortality in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (SARS-CoV2 infection), a single-center prospective observational study in France.
RESULTS
RESULTS
We prospectively included consecutive adults admitted to the intensive care unit (ICU) of a university-affiliated tertiary hospital for ARDS related to proven COVID-19, between March 2020 and July 2021. All patients were intubated. We compared two patient groups defined by whether an ICU ventilator or a less sophisticated ventilator such as a sophisticated turbine-based transport ventilator was used. Kaplan-Meier survival curves were plotted. Cox multivariate regression was performed to identify associations between patient characteristics and hospital mortality. We included 189 patients (140 [74.1%] men) with a median age of 65 years [IQR, 55-73], of whom 61 (32.3%) died before hospital discharge. By multivariate analysis, factors associated with in-hospital mortality were age ≥ 70 years (HR, 2.11; 95% CI, 1.24-3.59; P = 0.006), immunodeficiency (HR, 2.43; 95% CI, 1.16-5.09; P = 0.02) and serum creatinine ≥ 100 µmol/L (HR, 3.01; 95% CI, 1.77-5.10; P < 0.001) but not ventilator type. As compared to conventional ICU (equipped with ICU and anesthesiology ventilators), management in transient ICU (equipped with non-ICU turbine-based ventilators) was associated neither with a longer duration of invasive mechanical ventilation (18 [IQR, 11-32] vs. 21 [13-37] days, respectively; P = 0.39) nor with a longer ICU stay (24 [IQR, 14-40] vs. 27 [15-44] days, respectively; P = 0.44).
CONCLUSIONS
CONCLUSIONS
In ventilated patients with ARDS due to COVID-19, management in transient ICU equipped with non-ICU sophisticated turbine-based ventilators was not associated with worse outcomes compared to standard ICU, equipped with ICU ventilators. Although our study design is not powered to demonstrate any difference in outcome, our results after adjustment do not suggest any signal of harm when using these transport type ventilators as an alternative to ICU ventilators during COVID-19 surge.
Identifiants
pubmed: 35133543
doi: 10.1186/s13613-022-00981-2
pii: 10.1186/s13613-022-00981-2
pmc: PMC8821831
doi:
Types de publication
Journal Article
Langues
eng
Pagination
10Investigateurs
Sofia Abbad
(S)
Georges Abi Abdallah
(G)
Passem Ahmed
(P)
Marlène Amara
(M)
Marine Arrayago
(M)
Alix Aubry
(A)
Pauline Bargain
(P)
Jean-Pierre Bédos
(JP)
Hugo Bellut
(H)
Michael Benayoun
(M)
Hotman Benhamida
(H)
Laura Benchetrit
(L)
Johan Benhard
(J)
Emilie Boglietto
(E)
Raphaelle Bordier
(R)
Antoine Brizard
(A)
Amélie Cambriel
(A)
Steven Causeret
(S)
Raphaële Convers-Domart
(R)
Paul Chinardet
(P)
Anaïs Codorniu
(A)
Adrien Coeffic
(A)
Wandrille de Carrere
(W)
Cyril Dekeyser
(C)
Alix Delaroche
(A)
Chloé Descamps
(C)
Juliette Didier
(J)
Pascaline Dorges
(P)
Lucie Fanet
(L)
Camille Fauquenot
(C)
Claire Flaujac
(C)
Laura Gouzien
(L)
Louis Grandière
(L)
Juliana Henao-Brasseur
(J)
Jean-Didier Heymann
(JD)
Charles Hickel
(C)
Philippe Jullien
(P)
Myriam Lamamri
(M)
Bénédicte Le Clec'h
(B)
Marc Lessert
(M)
Yves Le Tulzo
(Y)
Bernard Livarek
(B)
Aurélien Maurizot
(A)
Céline Metzger
(C)
Hervé Michon
(H)
Marie-Sophie Minin
(MS)
Ghislane Nid-Bella
(G)
Marianne Offredo
(M)
Amael Ouassou
(A)
Hanna Paktoris
(H)
François Perier
(F)
Olivia Picq
(O)
Hélène Poirier
(H)
Jean-Herlé Raphalen
(JH)
Anne Roche
(A)
Ariane Roujansky
(A)
Thomas Quenesson
(T)
Jil Rouaux
(J)
Lucie Sabau
(L)
Marie Saleten
(M)
Marie Salvetti
(M)
Florence Sarfati
(F)
Pierre Squara
(P)
Celia Teissedre
(C)
Manon Terris
(M)
François Stephan
(F)
Fabienne Tamion
(F)
Jean-François Vax
(JF)
Benoît Veber
(B)
Cécile Vernet
(C)
Alexandre Wormser
(A)
Informations de copyright
© 2022. The Author(s).
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