Use of non-invasive respiratory supports in high-intensity internal medicine setting during the first two waves of the COVID-19 pandemic emergency in Italy: a multicenter, real-life experience.
Journal
Internal and emergency medicine
ISSN: 1970-9366
Titre abrégé: Intern Emerg Med
Pays: Italy
ID NLM: 101263418
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
received:
14
02
2023
accepted:
03
07
2023
medline:
18
9
2023
pubmed:
20
7
2023
entrez:
20
7
2023
Statut:
ppublish
Résumé
During the first two waves of the COVID-19 emergency in Italy, internal medicine high-dependency wards (HDW) have been organized to manage patients with acute respiratory failure (ARF). There is heterogeneous evidence about the feasibility and outcomes of non-invasive respiratory supports (NIRS) in settings outside the intensive care unit (ICU), including in patients deemed not eligible for intubation (i.e., with do-not-intubate, DNI status). Few data are available about the different NIRS modalities applied to ARF patients in the newly assembled internal medicine HDW. The main aim of our study was to describe a real-life experience in this setting of cure, focusing on feasibility and outcomes. We retrospectively collected data from COVID-19 patients with ARF needing NIRS and admitted to internal medicine HDW. Patients were treated with different modalities, that is high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), or non-invasive mechanical ventilation (NIMV). Switching among different NIRS during the hospitalization and the success rate (weaning with the same NIRS) or failure (endotracheal intubation-ETI or in-hospital death) were recorded. Three hundred thirty four ARF patients (median age 74 years), of which 158 (54%) had a DNI status, were included. CPAP, NIMV, and HFNC's success rates were 54, 33, and 13%, respectively. Although DNI status was strongly associated with death (Gehan-Breslow-Wilcoxon test p < 0.001), an acceptable success rate was observed in these patients using CPAP (47%). Multivariate regression models showed older age (odds ratio-OR 4.74), chronic ischemic heart disease (OR 2.76), high respiratory rate after 24 h (OR 7.13), and suspected acute respiratory distress syndrome-ARDS (OR 21.1) as predictors of mortality risk or ETI. Our real-life experience shows that NIRS was feasible in internal medicine HDW with an acceptable success rate. Although DNI patients had a worse prognosis, the use of NIRS represented a reasonable chance of treatment.
Identifiants
pubmed: 37470891
doi: 10.1007/s11739-023-03371-z
pii: 10.1007/s11739-023-03371-z
pmc: PMC10504094
doi:
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1777-1787Informations de copyright
© 2023. The Author(s).
Références
Remuzzi A, Remuzzi G (2020) COVID-19 and Italy: what next? Lancet 395:1225–1228
doi: 10.1016/S0140-6736(20)30627-9
pubmed: 32178769
pmcid: 7102589
Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, Cereda D, Coluccello A, Foti G, Fumagalli R, Iotti G, Latronico N, Lorini L, Merler S, Natalini G, Piatti A, Ranieri MV, Scandroglio AM, Storti E, Cecconi M, Pesenti A; COVID-19 Lombardy ICU Network (2020) Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA 323(16):1574–1581. doi: https://doi.org/10.1001/jama.2020.5394
Raoof S, Nava S, Carpati C, Hill NS (2020) High-flow, noninvasive ventilation and awake (nonintubation) proning in patients with Coronavirus Disease 2019 with respiratory failure. Chest 158(5):1992–2002. https://doi.org/10.1016/j.chest.2020.07.013
doi: 10.1016/j.chest.2020.07.013
pubmed: 32681847
Gorman E, Connolly B, Couper K, Perkins GD, McAuley DF (2021) Non-invasive respiratory support strategies in COVID-19. Lancet Respir Med 9(6):553–556. https://doi.org/10.1016/S2213-2600(21)00168-5
doi: 10.1016/S2213-2600(21)00168-5
pubmed: 33872588
pmcid: 8051928
Franco C, Facciolongo N, Tonelli R, Dongilli R, Vianello A, Pisani L, Scala R, Malerba M, Carlucci A, Negri EA, Spoladore G, Arcaro G, Tillio PA, Lastoria C, Schifino G, Tabbì L, Guidelli L, Guaraldi G, Ranieri VM, Clini E, Nava S (2020) Feasibility and clinical impact of out-of-ICU non-invasive respiratory support in patients with COVID-19-related pneumonia. Eur Respir J 56(5):2002130. https://doi.org/10.1183/13993003.02130-2020
doi: 10.1183/13993003.02130-2020
pubmed: 32747398
pmcid: 7397952
Bellani G, Grasselli G, Cecconi M, Antolini L, Borelli M, De Giacomi F, Bosio G, Latronico N, Filippini M, Gemma M, Giannotti C, Antonini B, Petrucci N, Zerbi SM, Maniglia P, Castelli GP, Marino G, Subert M, Citerio G, Radrizzani D, Mediani TS, Lorini FL, Russo FM, Faletti A, Beindorf A, Covello RD, Greco S, Bizzarri MM, Ristagno G, Mojoli F, Pradella A, Severgnini P, Da Macallè M, Albertin A, Ranieri VM, Rezoagli E, Vitale G, Magliocca A, Cappelleri G, Docci M, Aliberti S, Serra F, Rossi E, Valsecchi MG, Pesenti A, Foti G (2021) Noninvasive ventilatory support of patients with COVID-19 outside the intensive care units (WARd-COVID). Ann Am Thorac Soc 18(6):1020–1026. https://doi.org/10.1513/AnnalsATS.202008-1080OC
doi: 10.1513/AnnalsATS.202008-1080OC
pubmed: 33395553
pmcid: 8456729
Coppadoro A, Benini A, Fruscio R, Verga L, Mazzola P, Bellelli G, Carbone M, Mulinacci G, Soria A, Noè B, Beck E, Di Sciacca R, Ippolito D, Citerio G, Valsecchi MG, Biondi A, Pesci A, Bonfanti P, Gaudesi D, Bellani G, Foti G (2021) Helmet CPAP to treat hypoxic pneumonia outside the ICU: an observational study during the COVID-19 outbreak. Crit Care 25(1):80. https://doi.org/10.1186/s13054-021-03502-y
doi: 10.1186/s13054-021-03502-y
pubmed: 33627169
pmcid: 7903369
Cammarota G, Esposito T, Azzolina D, Cosentini R, Menzella F, Aliberti S, Coppadoro A, Bellani G, Foti G, Grasselli G, Cecconi M, Pesenti A, Vitacca M, Lawton T, Ranieri VM, Di Domenico SL, Resta O, Gidaro A, Potalivo A, Nardi G, Brusasco C, Tesoro S, Navalesi P, Vaschetto R, De Robertis E (2021) Non-invasive respiratory support outside the intensive care unit for acute respiratory failure related to coronavirus-19 disease: a systematic review and meta-analysis. Crit Care 25(1):268. https://doi.org/10.1186/s13054-021-03697-0
doi: 10.1186/s13054-021-03697-0
pubmed: 34330320
pmcid: 8324455
Corradini E, Ventura P, Ageno W, Cogliati CB, Muiesan ML, Girelli D, Pirisi M, Gasbarrini A, Angeli P, Querini PR, Bosi E, Tresoldi M, Vettor R, Cattaneo M, Piscaglia F, Brucato AL, Perlini S, Martelletti P, Pontremoli R, Porta M, Minuz P, Olivieri O, Sesti G, Biolo G, Rizzoni D, Serviddio G, Cipollone F, Grassi D, Manfredini R, Moreo GL, Pietrangelo A; SIMI-COVID-19 Collaborators (2021) Clinical factors associated with death in 3044 COVID-19 patients managed in internal medicine wards in Italy: results from the SIMI-COVID-19 study of the Italian Society of Internal Medicine (SIMI). Intern Emerg Med 16(4):1005–1015. doi: https://doi.org/10.1007/s11739-021-02742-8
Faraone A, Beltrame C, Crociani A, Carrai P, Lovicu E, Filetti S, Sbaragli S, Alessi C, Cameron Smith M, Angotti C, Fortini A (2021) Effectiveness and safety of non-invasive positive pressure ventilation in the treatment of COVID-19-associated acute hypoxemic respiratory failure: a single center, non-ICU setting experience. Intern Emerg Med 16(5):1183–1190. https://doi.org/10.1007/s11739-020-02562-2
doi: 10.1007/s11739-020-02562-2
pubmed: 33222116
Pietrantonio F, Rosiello F, Alessi E, Pascucci M, Rainone M, Cipriano E, Di Berardino A, Vinci A, Ruggeri M, Ricci S (2021) Burden of COVID-19 on Italian Internal Medicine Wards: Delphi, SWOT, and performance analysis after two pandemic waves in the Local Health Authority “Roma 6” Hospital Structures. Int J Environ Res Public Health 18(11):5999. https://doi.org/10.3390/ijerph18115999
doi: 10.3390/ijerph18115999
pubmed: 34204972
pmcid: 8199852
Cammarota G, Esposito T, Simonte R, Messina A, Cecconi M, Vaschetto R, Vetrugno L, Navalesi P, Azzolina D, Robba C, Pelosi P, Longhini F, Maggiore S, De Robertis E (2023) ‘Do-not-intubate’ orders in patients assisted by noninvasive respiratory support for acute hypoxaemic failure caused by coronavirus disease 2019; a systematic review and meta-analysis. Eur J Anaesthesiol Intensive Care Med 2:1
Definition Task Force ARDS, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome: the Berlin Definition. JAMA 307(23):2526–2533. https://doi.org/10.1001/jama.2012.5669
doi: 10.1001/jama.2012.5669
Hosmer D, Lemeshow S (1989) Applied logistic regression. Wiley, New York
Mike V, Stanley KE (eds) (1982) Statistics in medical research: methods and issues, with applications in cancer research. Wiley, New York
Wilson ME, Mittal A, Karki B, Dobler CC, Wahab A, Curtis JR, Erwin PJ, Majzoub AM, Montori VM, Gajic O, Murad MH (2020) Do-not-intubate orders in patients with acute respiratory failure: a systematic review and meta-analysis. Intensive Care Med 46(1):36–45. https://doi.org/10.1007/s00134-019-05828-2
doi: 10.1007/s00134-019-05828-2
pubmed: 31659387
Perkins GD, Ji C, Connolly BA, Couper K, Lall R, Baillie JK, Bradley JM, Dark P, Dave C, De Soyza A, Dennis AV, Devrell A, Fairbairn S, Ghani H, Gorman EA, Green CA, Hart N, Hee SW, Kimbley Z, Madathil S, McGowan N, Messer B, Naisbitt J, Norman C, Parekh D, Parkin EM, Patel J, Regan SE, Ross C, Rostron AJ, Saim M, Simonds AK, Skilton E, Stallard N, Steiner M, Vancheeswaran R, Yeung J, McAuley DF; RECOVERY-RS Collaborators (2022) Effect of non-invasive respiratory strategies on intubation or mortality among patients with acute hypoxemic respiratory failure and COVID-19: the RECOVERY-RS Randomized Clinical Trial. JAMA 327(6):546–558. doi: https://doi.org/10.1001/jama.2022.0028
Polok K, Fronczek J, Artigas A, Flaatten H, Guidet B, De Lange DW, Fjølner J, Leaver S, Beil M, Sviri S, Bruno RR, Wernly B, Bollen Pinto B, Schefold JC, Studzińska D, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Cecconi M, Jung C, Szczeklik W; COVIP Study Group (2022) Non-invasive ventilation in COVID-19 patients aged ≥ 70 years-a prospective multicentre cohort study. Crit Care 26(1):224. doi: https://doi.org/10.1186/s13054-022-04082
Musuuza JS, Watson L, Parmasad V, Putman-Buehler N, Christensen L, Safdar N (2021) Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: a systematic review and meta-analysis. PLoS One 16(5):e0251170. https://doi.org/10.1371/journal.pone.0251170
doi: 10.1371/journal.pone.0251170
pubmed: 33956882
pmcid: 8101968
Grasselli G, Tonetti T, Protti A, Langer T, Girardis M, Bellani G, Laffey J, Carrafiello G, Carsana L, Rizzuto C, Zanella A, Scaravilli V, Pizzilli G, Grieco DL, Di Meglio L, de Pascale G, Lanza E, Monteduro F, Zompatori M, Filippini C, Locatelli F, Cecconi M, Fumagalli R, Nava S, Vincent JL, Antonelli M, Slutsky AS, Pesenti A, Ranieri VM; collaborators (2020) Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study. Lancet Respir Med 8(12):1201–1208. doi: https://doi.org/10.1016/S2213-2600(20)30370-2
Crimi C, Noto A, Madotto F, Ippolito M, Nolasco S, Campisi R, De Vuono S, Fiorentino G, Pantazopoulos I, Chalkias A, Libra A, Mattei A, Scala R, Clini EM, Ergan B, Lujan M, Winck JC, Giarratano A, Carlucci A, Gregoretti C, Groff P, Cortegiani A; COVID-HIGH Investigators (2022) High-flow nasal oxygen versus conventional oxygen therapy in patients with COVID-19 pneumonia and mild hypoxaemia: a randomised controlled trial. Thorax. doi: https://doi.org/10.1136/thoraxjnl-2022-218806
Bandera A, Nobili A, Tettamanti M, Harari S, Bosari S, Mannucci PM; COVID-19 Network Working Group (2022) Clinical factors associated with death in 3044 COVID-19 patients managed in internal medicine wards in Italy: comment. Intern Emerg Med 17(1):299–302. doi: https://doi.org/10.1007/s11739-021-02797-7
Duan J, Chen L, Liu X, Bozbay S, Liu Y, Wang K, Esquinas AM, Shu W, Yang F, He D, Chen Q, Wei B, Chen B, Li L, Tang M, Yuan G, Ding F, Huang T, Zhang Z, Tang Z, Han X, Jiang L, Bai L, Hu W, Zhang R, Mina B (2022) An updated HACOR score for predicting the failure of non-invasive ventilation: a multicenter prospective observational study. Crit Care 26(1):196. https://doi.org/10.1186/s13054-022-04060-7
doi: 10.1186/s13054-022-04060-7
pubmed: 35786223
pmcid: 9250742
Manrique S, Claverias L, Magret M, Masclans JR, Bodi M, Trefler S, Canadell L, Díaz E, Sole-Violan J, Bisbal-Andrés E, Natera RG, Moreno AA, Vallverdu M, Ballesteros JC, Socias L, Vidal FG, Sancho S, Martin-Loeches I, Rodriguez A (2023) Timing of intubation and ICU mortality in COVID-19 patients: a retrospective analysis of 4198 critically ill patients during the first and second waves. BMC Anesthesiol 23(1):140. https://doi.org/10.1186/s12871-023-02081-5
doi: 10.1186/s12871-023-02081-5
pubmed: 37106321
pmcid: 10133910
Papoutsi E, Giannakoulis VG, Xourgia E, Routsi C, Kotanidou A, Siempos II (2021) Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies. Crit Care 25(1):121. https://doi.org/10.1186/s13054-021-03540-6
doi: 10.1186/s13054-021-03540-6
pubmed: 33766109
pmcid: 7993905
Francone M, Iafrate F, Masci GM, Coco S, Cilia F, Manganaro L, Panebianco V, Andreoli C, Colaiacomo MC, Zingaropoli MA, Ciardi MR, Mastroianni CM, Pugliese F, Alessandri F, Turriziani O, Ricci P, Catalano C (2020) Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol 30(12):6808–6817. https://doi.org/10.1007/s00330-020-07033-y
doi: 10.1007/s00330-020-07033-y
pubmed: 32623505
pmcid: 7334627