Association of ventilator type with hospital mortality in critically ill patients with SARS-CoV2 infection: a prospective study

Ferré, Alexis; Marquion, Fabien; Delord, Marc; Gros, Antoine; Lacave, Guillaume; Laurent, Virginie; Merceron, Sybille; Paul, Marine; Simon, C.; Troché, Gilles; Charbonnel, C.; Marque-Juillet, Stéphanie; Bruneel, Fabrice; Legriel, Stéphane

doi:10.1186/s13613-022-00981-2

Cited by 5 publications

(8 citation statements)

References 54 publications

(59 reference statements)

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“…The surge in patients with COVID-19 requiring hospitalization, ICU admission, and ventilator support has posed an unparalleled challenge to physicians, nurses, hospital managers, and healthcare systems. Due to the limitation and shortage of critical care equipment in ICUs, a considerable proportion of patients who need MV are treated with transport ventilators in hospital settings outside the ICU 10 , 17 . However, despite the widespread use of transport ventilators in medical centers, their impact on COVID-19 patients' outcomes is unclear.…”

Section: Discussionmentioning

confidence: 99%

“…A single-center prospective observational study by Ferre et al 17 , evaluated the association between ventilator type and hospital mortality in patients with ARDS related to COVID-19. They demonstrated that management in a transient ICU equipped with non-ICU sophisticated turbine-based ventilators was not associated with worse outcomes compared to a standard ICU equipped with ICU ventilators.…”

Section: Introductionmentioning

confidence: 99%

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1-year survival rate of SARS-CoV-2 infected patients with acute respiratory distress syndrome based on ventilator types: a multi-center study

Mahmoodpoor

Gohari-Moghadam

Rahimi–Bashar

et al. 2023

Sci Rep

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The aim of this study was to evaluate the association between types of ventilator and the one-year survival rate of patients with acute respiratory distress syndrome (ARDS) due to SARS‑CoV-2 infection. This multi-center, retrospective observational study was conducted on 1078 adult patients admitted to five university-affiliated hospitals in Iran who underwent mechanical ventilator (MV) due to ARDS. Of the 1078 patients, 781 (72.4%) were managed with ICU ventilators and 297 (27.6%) with transport ventilators. Overall mortality was significantly higher in patients supported with transport ventilator compared to patients supported with ICU ventilator (16.5% vs. 9.3% P = 0.001). Regression analysis revealed that the expected hazard overall increased with age (HR: 1.525, 95% CI 1.112–1.938, P = 0.001), opacity score (HR: 1.448, 95% CI 1.122–2.074, P = 0.001) and transport ventilator versus ICU ventilator (HR: 1.511, 95% CI 1.143–2.187, P = 0.029). The Kaplan–Meier curves of survival analysis showed that patients supported with ICU ventilator had a significantly higher 1-year survival rate (P = 0.001). In MV patients with ARDS due to COVID-19, management with non-ICU sophisticated ventilators was associated with a higher mortality rate compared to standard ICU ventilators. However, more studies are needed to determine the exact effect of ventilator types on the outcome of critically ill patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

1-year survival rate of SARS-CoV-2 infected patients with acute respiratory distress syndrome based on ventilator types: a multi-center study

Mahmoodpoor

Gohari-Moghadam

Rahimi–Bashar

et al. 2023

Sci Rep

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“…Second, ventilator availability in both ICUs differed. Ferré et al used a transport ventilator without identifying consequences regarding the outcome [ 15 ]. Because of the lack of intensive care specialized ventilators at the beginning of the crisis, the temporary ICU in our department was equipped with either older model or anaesthesia ventilators.…”

Section: Discussionmentioning

confidence: 99%

Temporary ICUs during the COVID-19 pandemic first wave: description of the cohort at a French centre

et al. 2022

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Background During the COVID-19 first wave in France, the capacity of intensive care unit (ICU) beds almost doubled, mainly because of the opening of temporary ICUs with staff and equipment from anaesthesia. Objectives We aim to investigate if the initial management in temporary ICU is associated with a change in ICU mortality and short-term prognosis. Design Retrospective single-centre cohort study. Setting Surgical ICU of the Bichat Claude Bernard University Hospital during the COVID-19 “first wave” (from 18 March to 10 April 2020). Patients All consecutive patients older than 18 years of age with laboratory-confirmed SARS-CoV-2 infection and/or typical radiological patterns were included during their first stay in the ICU for COVID-19. Intervention Patients were admitted to a temporary ICU if no room was available in the classical ICU and if they needed invasive mechanical ventilation but no renal replacement therapy or Extracorporeal Membrane Oxygenation (ECMO) in the short term. The temporary ICUs were managed by mixed teams (from the ICU and anaesthesiology departments) following a common protocol and staff meetings. Main outcome measure ICU mortality Results Among the 59 patients admitted, 37 (62.7%) patients had initial management in the temporary ICU. They had the same characteristics on admission and the same medical management as patients admitted to the classical ICU. ICU mortality was similar in the 2 groups (32.4% in temporary ICUs versus 40.9% in classical ICUs; p=0.58). SAPS-II and ECMO use were associated with mortality in multivariate analysis but not admission to the temporary ICU. Conclusion In an overload context of the ICU of a geographical area, our temporary ICU model allowed access to intensive care for all patients requiring it without endangering them.

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“…The online supplementary e-Figure 1 shows the monthly incidence of ICU case fatality rates throughout the pandemic between waves. The results showed a significant difference in ICU length of stay regarding the COVID wave as follows: 20 [IQR: in W1 versus 14 [IQR: [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] days in W2 and 12 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] days in W3, p = 0.001. The results on survival rates did not show significant differences in ICU, hospital, or day-90 survival for patients according to the wave (Table 2).…”

Section: Comparison According To the Epidemic Wavesmentioning

confidence: 99%

“…During the first wave, intensivists have faced a new severe pulmonary infectious disease with high homogeneity in patient characteristics according to published studies. Pulmonary patterns were mild to severe acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation (MV) as a cornerstone of symptomatic ICU management at this time [5][6][7][8][9][10]. From January to June 2020, no treatment has proven to be effective, and international guidelines recommended symptomatic ICU management and/or therapeutic options only in the context of randomized controlled studies [11,12].…”

Section: Introductionmentioning

confidence: 99%

Unchanged Characteristics and Survival among Critically Ill COVID-19 Patients during First, Second, and Third Waves: A Prospective Observational Cohort

Ferré,

Lamamri,

Delord

et al. 2023

Respiration

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Background: This study was carried out to compare characteristics and outcomes in patients with acute respiratory failure related to COVID-19 during first, second, and third waves. Methods: We included consecutive adults admitted to the intensive care unit between March 2020 and July 2021. We compared three groups defined by the epidemic intake phase: waves 1 (W1), 2 (W2), and 3 (W3). Results: We included 289 patients. Two hundred and eight (72%) patients were men with a median age of 63 years (IQR: 54–72), of whom 68 (23.6%) died in hospital. High-flow nasal oxygen (HFNO) was inversely associated with the need for invasive mechanical ventilation (MV) in multivariate analysis (p = 0.003) but not dexamethasone (p = 0.25). The day-90 mortality rate did not vary from W1 (27.4%) to W2 (23.9%) and W3 (22%), p = 0.67. By multivariate analysis, older age (odds ratio [OR]: 0.94/year, p < 0.001), immunodeficiency (OR: 0.33, p = 0.04), acute kidney injury (OR: 0.26, p < 0.001), and invasive MV (OR: 0.13, p < 0.001) were inversely associated with higher day-90 survival as opposed to the use of intermediate heparin thromboprophylaxis dose (OR: 3.21, p = 0.006). HFNO use and dexamethasone were not associated with higher day-90 survival (p = 0.24 and p = 0.56, respectively). Conclusions: In patients with acute respiratory failure due to COVID-19, survival did not change between first, second, and third waves while the use of invasive MV decreased. HFNO or intravenous steroids were not associated with better outcomes, whereas the use of intermediate dose of heparin for thromboprophylaxis was associated with higher day-90 survival. Larger multicentric studies are needed to confirm our findings.

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Association of ventilator type with hospital mortality in critically ill patients with SARS-CoV2 infection: a prospective study

Cited by 5 publications

References 54 publications

1-year survival rate of SARS-CoV-2 infected patients with acute respiratory distress syndrome based on ventilator types: a multi-center study

1-year survival rate of SARS-CoV-2 infected patients with acute respiratory distress syndrome based on ventilator types: a multi-center study

Temporary ICUs during the COVID-19 pandemic first wave: description of the cohort at a French centre

Unchanged Characteristics and Survival among Critically Ill COVID-19 Patients during First, Second, and Third Waves: A Prospective Observational Cohort

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