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

被引：48

作者：

Wendel Garcia, Pedro D. ^{[1
,2
]}

Aguirre-Bermeo, Hernan ^{[3
]}

Buehler, Philipp K. ^{[1
]}

Alfaro-Farias, Mario ^{[4
]}

Yuen, Bernd ^{[5
]}

David, Sascha ^{[6
]}

Tschoellitsch, Thomas ^{[7
,8
]}

Wengenmayer, Tobias ^{[9
]}

Korsos, Anita ^{[10
]}

Fogagnolo, Alberto ^{[11
]}

Kleger, Gian-Reto ^{[12
]}

Wu, Maddalena A. ^{[13
]}

Colombo, Riccardo ^{[14
]}

Turrini, Fabrizio ^{[15
]}

Potalivo, Antonella ^{[16
]}

Rezoagli, Emanuele ^{[17
]}

Rodriguez-Garcia, Raquel ^{[18
]}

Castro, Pedro ^{[19
]}

Lander-Azcona, Arantxa ^{[20
]}

Martin-Delgado, Maria C. ^{[21
]}

Lozano-Gomez, Herminia ^{[22
]}

Ensner, Rolf ^{[23
]}

Michot, Marc P. ^{[24
]}

Gehring, Nadine ^{[25
]}

Schott, Peter ^{[26
]}

Siegemund, Martin ^{[27
]}

Merki, Lukas ^{[28
]}

Wiegand, Jan ^{[29
]}

Jeitziner, Marie M. ^{[30
]}

Laube, Marcus ^{[31
]}

Salomon, Petra ^{[32
]}

Hillgaertner, Frank ^{[33
]}

Dullenkopf, Alexander ^{[34
]}

Ksouri, Hatem ^{[35
]}

Cereghetti, Sara ^{[36
]}

Grazioli, Serge ^{[37
]}

Burkle, Christian ^{[38
]}

Marrel, Julien ^{[39
]}

Fleisch, Isabelle ^{[40
]}

Perez, Marie-Helene ^{[41
]}

Baltussen Weber, Anja ^{[42
]}

Ceruti, Samuele ^{[43
]}

Marquardt, Katharina ^{[44
]}

Hubner, Tobias ^{[45
]}

Redecker, Hermann ^{[46
]}

Studhalter, Michael ^{[42
,47
]}

Stephan, Michael ^{[43
,48
]}

Selz, Daniela ^{[49
]}

Pietsch, Urs ^{[50
]}

Ristic, Anette ^{[51
]}

机构：

[1] Univ Hosp Zurich, Inst Intens Care Med, Zurich, Switzerland

[2] Univ Zurich, RISC19 ICU Registry Board, Zurich, Switzerland

[3] Hosp Vicente Corral Moscoso, Unidad Cuidados Intens, Cuenca, Ecuador

[4] Hosp Nostra Senyora Meritxell, Unidad Cuidados Intens, Escaldes Engordany, Andorra

[5] Spital Buelach, Interdisziplinaere Intensivstat, Bulach, Switzerland

[6] Hannover Med Sch, Dept Nephrol & Hypertens, Hannover, Germany

[7] Kepler Univ Hosp GmbH, Dept Anesthesiol & Crit Care Med, Linz, Austria

[8] Johannes Kepler Univ Linz, Linz, Austria

[9] Univ Freiburg, Med Ctr, Dept Med Interdisciplinary Med Intens Care 3, Freiburg, Germany

[10] Univ Szeged, Dept Anaethesiol & Intens Care, Szeged, Hungary

[11] Azienda Osped Univ Ferrara, Anesthesia & Intens Care, Cona, Italy

[12] Kantonsspital St Gallen, Med Intensivstat, St Gallen, Switzerland

[13] ASST Fatebenefratelli Sacco Luigi Sacco Hosp, Dept Internal Med, Milan, Italy

[14] ASST Fatebenefratelli Sacco Luigi Sacco Hosp, Div Anesthesia & Intens Care, Milan, Italy

[15] Azienda Osped Univ Modena, Internal Med, Modena, Italy

[16] Osped Infermi, UOC Anestesia & Rianimaz, Rimini, Italy

[17] Grp Osped San Donato, Policlin San Marco, Dept Anesthesia & Intens Care Med, Bergamo, Italy

[18] Complejo Hosp Univ A Coruna, Serv Med Intens, La Coruna, Spain

[19] Hosp Clin Barcelona, Med Intens Care Unit, Barcelona, Spain

[20] Hosp Gen San Jorge, Serv Med Intens, Huesca, Spain

[21] Hosp Univ Torrejon, Serv Med Intens, Madrid, Spain

[22] Hosp Clin Univ Lozano Blesa, Unidad Cuidados Intens, Zaragoza, Spain

[23] Kantonsspital Aarau, Klin Operat Intensivmed, Aarau, Switzerland

[24] Kantonsspital Aarau, Med Intensivstat, Aarau, Switzerland

[25] Kantonsspital Schaffhausen, Intensivstat, Schaffhausen, Switzerland

[26] Zuger Kantonsspital AG, Inst Anesthaesie & Intensivmed, Baar, Switzerland

[27] Univ Spital Basel, Dept Intensivmed, Basel, Switzerland

[28] St Clara Hosp, Intensivmed, Basel, Switzerland

[29] Lindenhofspital, Interdisziplinaere Intensivmed, Bern, Switzerland

[30] Univ Hosp Bern, Dept Intens Care Med, Inselspital, Bern, Switzerland

[31] Spitalzentrum Biel, Dept Intens Care Med, Biel, Switzerland

[32] Reg Alspital Emmental AG, Intensivstat, Burgdorf, Switzerland

[33] Kantonsspital Graubuenden, Intensivmed, Chur, Switzerland

[34] Spital Thurgau, Inst Anaesthesie & Intensivmed, Frauenfeld, Switzerland

[35] Hop Cantonal Fribourg, Soins Intensifs, Fribourg, Switzerland

[36] Univ Hosp Geneva, Div Intens Care, Geneva, Switzerland

[37] Univ Hosp Geneva, Div Neonatal & Pediat Intens Care, Geneva, Switzerland

[38] Spital Grabs, Intensivstat, Grabs, Switzerland

[39] See Spital Horgen & Kilchberg, Inst Anaesthesiol Intensivmed & Rettungsmed, Horgen, Switzerland

[40] Hirslanden Clin Cecil, Soins Intensifs, Lausanne, Switzerland

[41] Univ Hosp Lausanne, Pediat Intens Care Unit, Lausanne, Switzerland

[42] Kantonsspital Baselland, Anaesthesie & Intensivmed, Liestal, Switzerland

[43] Clin Luganese Moncucco, Dipartimento Area Crit, Lugano, Switzerland

[44] Spital Maennedorf AG, Interdisziplinaere Intensivstat, Mannedorf, Switzerland

[45] Spital Thurgau, Inst Anaesthesie & Intensivmed, Muensterlingen, Switzerland

[46] Schweizer Paraplegikerzentrum Nottwil, Intensivmed, Nottwil, Switzerland

[47] Kantonsspital Olten, Intensivmed & Intermediate Care, Olten, Switzerland

[48] Spital Oberengadin, Intensivmed, Samedan, Switzerland

[49] Spital Schwyz, Anaesthesie Intensivmed Schmerzmed, Schwyz, Switzerland

[50] Kantonsspital St Gallen, Dept Anesthesiol & Intens Care Med, St Gallen, Switzerland

来源：

CRITICAL CARE | 2021年 / 25卷 / 01期

关键词：

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

D O I：

10.1186/s13054-021-03580-y

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

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.

引用

页数：12

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