Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort

on behalf of RISC-19-ICU Investigators

doi:10.1186/s13054-021-03580-y

Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort

on behalf of RISC-19-ICU Investigators

University of Zurich
Hospital Vicente Corral Moscoso
Hospital Nostra Senyora de Meritxell
Interdisziplinaere Intensivstation
Hannover Medical School
Johannes Kepler University Linz
University of Freiburg
University of Szeged
Arcispedale Sant'Anna Ferrara
Cantonal Hospital St. Gallen
ASST Fatebenefratelli Sacco
University of Modena and Reggio Emilia
Ospedale Infermi
IRCCS Policlinico San Donato
Hospital Juan Canalejo
Hospital Clinic CICU
Hospital San Jorge
Hospital Universitario de Torrejón
Hospital Clínico Universitario Lozano Blesa
Cantonal Hospital Aarau
Kantonsspital Schaffhausen
Zuger Kantonsspital AG
University of Basel
St. Claraspital AG
Lindenhofspital
University of Bern
Spitalzentrum Biel
Regionalspital Emmental AG
Kantonsspital Graubünden
Spital Thurgau AG
Hôpital Cantonal de Fribourg
University of Geneva
Spital Grabs
See-Spital Horgen & Kilchberg
Hirslanden Clinique Cecil
University of Lausanne
Kantonsspital Liestal
Clinica Luganese Moncucco
Spital Maennedorf AG
Swiss Paraplegic Centre
Olten Cantonal Hospital
Spital Oberengadin
Spital Schwyz
Kantonsspital Nidwalden
Spital Simmental-Thun-Saanenland AG
Spitalzentrum Oberwallis
EHNV
Stadtspital Triemli
Klinik Hirslanden
Samsun Training and Research Hospital
Hôpital de Nyon
Erasmus University Rotterdam
CHU de Nancy
Generalitat de Catalunya

Research output: Contribution to journal › Article › peer-review

51 Scopus citations

Abstract

Background: Uncertainty about the optimal respiratory support strategies in critically ill COVID-19 patients is widespread. While the risks and benefits of noninvasive techniques versus early invasive mechanical ventilation (IMV) are intensely debated, actual evidence is lacking. We sought to assess the risks and benefits of different respiratory support strategies, employed in intensive care units during the first months of the COVID-19 pandemic on intubation and intensive care unit (ICU) mortality rates. Methods: Subanalysis of a prospective, multinational registry of critically ill COVID-19 patients. Patients were subclassified into standard oxygen therapy ≥10 L/min (SOT), high-flow oxygen therapy (HFNC), noninvasive positive-pressure ventilation (NIV), and early IMV, according to the respiratory support strategy employed at the day of admission to ICU. Propensity score matching was performed to ensure comparability between groups. Results: Initially, 1421 patients were assessed for possible study inclusion. Of these, 351 patients (85 SOT, 87 HFNC, 87 NIV, and 92 IMV) remained eligible for full analysis after propensity score matching. 55% of patients initially receiving noninvasive respiratory support required IMV. The intubation rate was lower in patients initially ventilated with HFNC and NIV compared to those who received SOT (SOT: 64%, HFNC: 52%, NIV: 49%, p = 0.025). Compared to the other respiratory support strategies, NIV was associated with a higher overall ICU mortality (SOT: 18%, HFNC: 20%, NIV: 37%, IMV: 25%, p = 0.016). Conclusion: In this cohort of critically ill patients with COVID-19, a trial of HFNC appeared to be the most balanced initial respiratory support strategy, given the reduced intubation rate and comparable ICU mortality rate. Nonetheless, considering the uncertainty and stress associated with the COVID-19 pandemic, SOT and early IMV represented safe initial respiratory support strategies. The presented findings, in agreement with classic ARDS literature, suggest that NIV should be avoided whenever possible due to the elevated ICU mortality risk.

Original language	English
Article number	175
Journal	Critical Care
Volume	25
Issue number	1
DOIs	https://doi.org/10.1186/s13054-021-03580-y
State	Published - Dec 2021
Externally published	Yes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

ARDS
COVID-19
High flow oxygen therapy
Invasive mechanical ventilation
Noninvasive mechanical ventilation
Patient self-inflicted lung injury
Respiratory support
Standard oxygen therapy

Access to Document

10.1186/s13054-021-03580-y

Cite this

@article{3575d2d549914db69ca47484e77d97ee,

title = "Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort",

abstract = "Background: Uncertainty about the optimal respiratory support strategies in critically ill COVID-19 patients is widespread. While the risks and benefits of noninvasive techniques versus early invasive mechanical ventilation (IMV) are intensely debated, actual evidence is lacking. We sought to assess the risks and benefits of different respiratory support strategies, employed in intensive care units during the first months of the COVID-19 pandemic on intubation and intensive care unit (ICU) mortality rates. Methods: Subanalysis of a prospective, multinational registry of critically ill COVID-19 patients. Patients were subclassified into standard oxygen therapy ≥10 L/min (SOT), high-flow oxygen therapy (HFNC), noninvasive positive-pressure ventilation (NIV), and early IMV, according to the respiratory support strategy employed at the day of admission to ICU. Propensity score matching was performed to ensure comparability between groups. Results: Initially, 1421 patients were assessed for possible study inclusion. Of these, 351 patients (85 SOT, 87 HFNC, 87 NIV, and 92 IMV) remained eligible for full analysis after propensity score matching. 55\% of patients initially receiving noninvasive respiratory support required IMV. The intubation rate was lower in patients initially ventilated with HFNC and NIV compared to those who received SOT (SOT: 64\%, HFNC: 52\%, NIV: 49\%, p = 0.025). Compared to the other respiratory support strategies, NIV was associated with a higher overall ICU mortality (SOT: 18\%, HFNC: 20\%, NIV: 37\%, IMV: 25\%, p = 0.016). Conclusion: In this cohort of critically ill patients with COVID-19, a trial of HFNC appeared to be the most balanced initial respiratory support strategy, given the reduced intubation rate and comparable ICU mortality rate. Nonetheless, considering the uncertainty and stress associated with the COVID-19 pandemic, SOT and early IMV represented safe initial respiratory support strategies. The presented findings, in agreement with classic ARDS literature, suggest that NIV should be avoided whenever possible due to the elevated ICU mortality risk.",

keywords = "ARDS, COVID-19, High flow oxygen therapy, Invasive mechanical ventilation, Noninvasive mechanical ventilation, Patient self-inflicted lung injury, Respiratory support, Standard oxygen therapy",

author = "\{on behalf of RISC-19-ICU Investigators\} and \{Wendel Garcia\}, \{Pedro D.\} and Hern{\'a}n Aguirre-Bermeo and Buehler, \{Philipp K.\} and Mario Alfaro-Farias and Bernd Yuen and Sascha David and Thomas Tschoellitsch and Tobias Wengenmayer and Anita Korsos and Alberto Fogagnolo and Kleger, \{Gian Reto\} and Wu, \{Maddalena A.\} and Riccardo Colombo and Fabrizio Turrini and Antonella Potalivo and Emanuele Rezoagli and Raquel Rodr{\'i}guez-Garc{\'i}a and Pedro Castro and Arantxa Lander-Azcona and Mart{\'i}n-Delgado, \{Maria C.\} and Herminia Lozano-G{\'o}mez and Rolf Ensner and Michot, \{Marc P.\} and Nadine Gehring and Peter Schott and Martin Siegemund and Lukas Merki and Jan Wiegand and Jeitziner, \{Marie M.\} and Marcus Laube and Petra Salomon and Frank Hillgaertner and Alexander Dullenkopf and Hatem Ksouri and Sara Cereghetti and Serge Grazioli and Christian B{\"u}rkle and Julien Marrel and Isabelle Fleisch and Perez, \{Marie Helene\} and \{Baltussen Weber\}, Anja and Samuele Ceruti and Katharina Marquardt and Tobias H{\"u}bner and Hermann Redecker and Michael Studhalter and Michael Stephan and Daniela Selz and Urs Pietsch and Anette Ristic",

note = "Publisher Copyright: {\textcopyright} 2021, The Author(s).",

year = "2021",

month = dec,

doi = "10.1186/s13054-021-03580-y",

language = "Ingl{\'e}s",

volume = "25",

journal = "Critical Care",

issn = "1364-8535",

number = "1",

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TY - JOUR

T1 - Implications of early respiratory support strategies on disease progression in critical COVID-19

T2 - a matched subanalysis of the prospective RISC-19-ICU cohort

AU - on behalf of RISC-19-ICU Investigators

AU - Wendel Garcia, Pedro D.

AU - Aguirre-Bermeo, Hernán

AU - Buehler, Philipp K.

AU - Alfaro-Farias, Mario

AU - Yuen, Bernd

AU - David, Sascha

AU - Tschoellitsch, Thomas

AU - Wengenmayer, Tobias

AU - Korsos, Anita

AU - Fogagnolo, Alberto

AU - Kleger, Gian Reto

AU - Wu, Maddalena A.

AU - Colombo, Riccardo

AU - Turrini, Fabrizio

AU - Potalivo, Antonella

AU - Rezoagli, Emanuele

AU - Rodríguez-García, Raquel

AU - Castro, Pedro

AU - Lander-Azcona, Arantxa

AU - Martín-Delgado, Maria C.

AU - Lozano-Gómez, Herminia

AU - Ensner, Rolf

AU - Michot, Marc P.

AU - Gehring, Nadine

AU - Schott, Peter

AU - Siegemund, Martin

AU - Merki, Lukas

AU - Wiegand, Jan

AU - Jeitziner, Marie M.

AU - Laube, Marcus

AU - Salomon, Petra

AU - Hillgaertner, Frank

AU - Dullenkopf, Alexander

AU - Ksouri, Hatem

AU - Cereghetti, Sara

AU - Grazioli, Serge

AU - Bürkle, Christian

AU - Marrel, Julien

AU - Fleisch, Isabelle

AU - Perez, Marie Helene

AU - Baltussen Weber, Anja

AU - Ceruti, Samuele

AU - Marquardt, Katharina

AU - Hübner, Tobias

AU - Redecker, Hermann

AU - Studhalter, Michael

AU - Stephan, Michael

AU - Selz, Daniela

AU - Pietsch, Urs

AU - Ristic, Anette

PY - 2021/12

Y1 - 2021/12

N2 - Background: Uncertainty about the optimal respiratory support strategies in critically ill COVID-19 patients is widespread. While the risks and benefits of noninvasive techniques versus early invasive mechanical ventilation (IMV) are intensely debated, actual evidence is lacking. We sought to assess the risks and benefits of different respiratory support strategies, employed in intensive care units during the first months of the COVID-19 pandemic on intubation and intensive care unit (ICU) mortality rates. Methods: Subanalysis of a prospective, multinational registry of critically ill COVID-19 patients. Patients were subclassified into standard oxygen therapy ≥10 L/min (SOT), high-flow oxygen therapy (HFNC), noninvasive positive-pressure ventilation (NIV), and early IMV, according to the respiratory support strategy employed at the day of admission to ICU. Propensity score matching was performed to ensure comparability between groups. Results: Initially, 1421 patients were assessed for possible study inclusion. Of these, 351 patients (85 SOT, 87 HFNC, 87 NIV, and 92 IMV) remained eligible for full analysis after propensity score matching. 55% of patients initially receiving noninvasive respiratory support required IMV. The intubation rate was lower in patients initially ventilated with HFNC and NIV compared to those who received SOT (SOT: 64%, HFNC: 52%, NIV: 49%, p = 0.025). Compared to the other respiratory support strategies, NIV was associated with a higher overall ICU mortality (SOT: 18%, HFNC: 20%, NIV: 37%, IMV: 25%, p = 0.016). Conclusion: In this cohort of critically ill patients with COVID-19, a trial of HFNC appeared to be the most balanced initial respiratory support strategy, given the reduced intubation rate and comparable ICU mortality rate. Nonetheless, considering the uncertainty and stress associated with the COVID-19 pandemic, SOT and early IMV represented safe initial respiratory support strategies. The presented findings, in agreement with classic ARDS literature, suggest that NIV should be avoided whenever possible due to the elevated ICU mortality risk.

AB - Background: Uncertainty about the optimal respiratory support strategies in critically ill COVID-19 patients is widespread. While the risks and benefits of noninvasive techniques versus early invasive mechanical ventilation (IMV) are intensely debated, actual evidence is lacking. We sought to assess the risks and benefits of different respiratory support strategies, employed in intensive care units during the first months of the COVID-19 pandemic on intubation and intensive care unit (ICU) mortality rates. Methods: Subanalysis of a prospective, multinational registry of critically ill COVID-19 patients. Patients were subclassified into standard oxygen therapy ≥10 L/min (SOT), high-flow oxygen therapy (HFNC), noninvasive positive-pressure ventilation (NIV), and early IMV, according to the respiratory support strategy employed at the day of admission to ICU. Propensity score matching was performed to ensure comparability between groups. Results: Initially, 1421 patients were assessed for possible study inclusion. Of these, 351 patients (85 SOT, 87 HFNC, 87 NIV, and 92 IMV) remained eligible for full analysis after propensity score matching. 55% of patients initially receiving noninvasive respiratory support required IMV. The intubation rate was lower in patients initially ventilated with HFNC and NIV compared to those who received SOT (SOT: 64%, HFNC: 52%, NIV: 49%, p = 0.025). Compared to the other respiratory support strategies, NIV was associated with a higher overall ICU mortality (SOT: 18%, HFNC: 20%, NIV: 37%, IMV: 25%, p = 0.016). Conclusion: In this cohort of critically ill patients with COVID-19, a trial of HFNC appeared to be the most balanced initial respiratory support strategy, given the reduced intubation rate and comparable ICU mortality rate. Nonetheless, considering the uncertainty and stress associated with the COVID-19 pandemic, SOT and early IMV represented safe initial respiratory support strategies. The presented findings, in agreement with classic ARDS literature, suggest that NIV should be avoided whenever possible due to the elevated ICU mortality risk.

KW - ARDS

KW - COVID-19

KW - High flow oxygen therapy

KW - Invasive mechanical ventilation

KW - Noninvasive mechanical ventilation

KW - Patient self-inflicted lung injury

KW - Respiratory support

KW - Standard oxygen therapy

UR - https://www.scopus.com/pages/publications/85106909379

U2 - 10.1186/s13054-021-03580-y

DO - 10.1186/s13054-021-03580-y

M3 - Artículo

C2 - 34034782

AN - SCOPUS:85106909379

SN - 1364-8535

VL - 25

JO - Critical Care

JF - Critical Care

IS - 1

M1 - 175

ER -

Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort

Abstract

UN SDGs

Keywords

Access to Document

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