Noninvasive Versus Invasive Ventilation in COVID-19: One Size Does Not Fit All!

Rahmanzade, Ramin; Rahmanzadeh, Reza; Tabarsi, Payam; Hashemian, Seyed Mohammadreza

doi:10.1213/ane.0000000000004943

Cited by 22 publications

(22 citation statements)

References 7 publications

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“…Our research shows that COVID-19 patients with respiratory failure were given an early application of invasive ventilation was associated with better outcomes. Our result was different from the report of the LUNG SAFE multicenter study, which indicate that no signi cant difference can be observed in ICU and hospital mortality rates of patients with ARDS receiving non-invasive ventilation or mechanical ventilation [46,47]. The application of noninvasive ventilation versus invasive ventilation in the management of COVID-19 patients with ARDS continues to be controversial [47].…”

Section: Cox Regression Analysis Of the Factors Associated With The Ocontrasting

confidence: 82%

Systemic Immune-Inflammatory Index predicts prognosis of patients with COVID-19: a retrospective study

Huang

Pan

et al. 2020

Preprint

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Background Our study aimed to investigate the prognostic value of a novel inflammatory index, systemic immune-inflammation index (SII), with the clinical outcomes of patients infected with coronavirus disease 2019 (COVID-19).Methods We evaluated a cohort study of COVID-19 patients (18–95 years old) in Tongji Hospital of Huazhong University of Science and Technology from January 28th 2020 to February 29th 2020. The enrolled patients were divided into two groups (including low-SII group and high-SII group) according to the cut-off point which is analyzed by receiver operating characteristic (ROC) curve. Univariate and multivariate COX regression analysis were performed to identify the factors associated with the outcomes of patients with COVID-19 infection. The primary and secondary outcome were in-hospital mortality and the development of acute respiratory distress syndrome (ARDS), respectively.Results A number of 326 adult patients (43.87% males, 61.22 ± 0.86 years) were enrolled in the final analyses. There were 147 cases (45.09%) died in hospital and 116 patients (35.58%) developed ARDS. ROC curve analysis indicated that the SII had a greater prediction accuracy in predicting the in-hospital mortality (area under the curve [AUC] = 0.789, sensitivity = 69.90%, specificity = 70.80%) and the development of ARDS (AUC = 0.736, sensitivity = 67.80%, specificity = 71.10%). Kaplan-Meier analysis revealed that patients in high-SII group had a greater risk of adverse clinical outcomes (all P < 0.001). The multivariate Cox regression analysis indicated that elevated SII was found as the risk predictor of in-hospital mortality (hazard ratio [HR] = 2.839, 95% confidence interval [CI] = 1.116–7.222, P = 0.028) and the developed ARDS (HR = 6.832, 95%CI = 2.583–18.074, P < 0.001). Additional significant independent predictor for adverse outcomes was the lymphocyte proportion. What’s more, it suggests that the invasive mechanical ventilation performed in the early stage of the disease progression may be beneficial for patients.Conclusion SII, a novel biomarker, might be a remarkable prognostic indicator to assess the in-hospital mortality and the development of ARDS in patients with COVID-19 and help for clinical risk assessment.

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Section: Cox Regression Analysis Of the Factors Associated With The Ocontrasting

confidence: 82%

Systemic Immune-Inflammatory Index predicts prognosis of patients with COVID-19: a retrospective study

Huang

Pan

et al. 2020

Preprint

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“…Moreover, there was a fear that NIV could generate an aerosol. It was quite late into the pandemic that NIV was advocated as the preferred alternative, especially for patients without significant co-morbidities [28].…”

Section: Resultsmentioning

confidence: 99%

Mortality of Patients With Severe COVID-19 in the Intensive Care Unit: An Observational Study From a Major COVID-19 Receiving Hospital

Rahim¹,

Amin²,

Noor³

et al. 2020

Cureus

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To determine the mortality of patients with severe COVID-19 in the intensive care unit (ICU) in relation to age, gender, co-morbidities, ventilatory status, and length of stay (LOS). Methods This was a cross-sectional study based on data retrieved for 204 patients admitted to the ICU of Hayatabad Medical Complex, Peshawar, Pakistan, from April to August 2020. Study variables were age, gender, comorbid conditions, ventilatory status, and length of stay (LOS). The data were analyzed using SPSS version 21 (IBM Corp., Armonk, NY). The independent t-test and the chi-square test were used to compare the means and frequencies of variables. Multivariate regression analysis was used to predict the likelihood of mortality. Results The overall mortality was 77%. Non-invasive ventilation (NIV) was administered to 61.8% of patients. Mortality was higher for invasive mechanical ventilation (IMV) (93.6% vs 66.7%, p<0.001) and for over 60 years (87.3% vs 72.3%, p=0.019). Mortality without co-morbidities was 75.2%. Comparative mortality rates for at least one co-morbidity (79.7%), diabetes mellitus (80.0%), hypertension (100%), diabetes mellitus and hypertension both (87.1%), and chronic obstructive pulmonary disease (75%) were insignificant. The LOS for survivors was longer (8.9±8.9 versus 5.4±5.2 days, p=0.017). The LOS < 24h was associated with higher mortality (85.9% vs 72.9%, p=0.040). On multivariable regression, the likelihood of mortality was high for IMV (7.330, 95% CI 2.667-20.143, p<0.001) and elderly (>60 years) patients (2.607, 95%CI 1.063-6.394, p=0.036). Mortality decreased with LOS longer than 24h (0.412, 95%CI 0.173-0.982, p=0.045). Comorbidities did not have any effect on mortality. Conclusions Age more than 60 years and IMV were independent risk factors for higher mortality. Longer ICU stay, specifically more than 24 hours, was associated with lower mortality but LOS less than 24 hours might not have a causal relationship with mortality. The odds of survival were not affected by co-morbidities.

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“…Higher P/F rations and no difference in inflammatory parameters between deceased and survivors (Tables 2 and 3 ), suggest less sick patients were intubated. Based on developing best practices at the time and due to the uncertainty of aerosol transmission, intubation was performed earlier and non-invasive positive pressure ventilation was avoided [ 30 ]. This was consistent with care in other institutions.…”

Section: Discussionmentioning

confidence: 99%

ICU outcomes and survival in patients with severe COVID-19 in the largest health care system in central Florida

et al. 2021

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Background Observational studies have consistently described poor clinical outcomes and increased ICU mortality in patients with severe coronavirus disease 2019 (COVID-19) who require mechanical ventilation (MV). Our study describes the clinical characteristics and outcomes of patients with severe COVID-19 admitted to ICU in the largest health care system in the state of Florida, United States. Methods Retrospective cohort study of patients admitted to ICU due to severe COVID-19 in AdventHealth health system in Orlando, Florida from March 11th until May 18th, 2020. Patients were characterized based on demographics, baseline comorbidities, severity of illness, medical management including experimental therapies, laboratory markers and ventilator parameters. Major clinical outcomes analyzed at the end of the study period were: hospital and ICU length of stay, MV-related mortality and overall hospital mortality of ICU patients. Results Out of total of 1283 patients with COVID-19, 131 (10.2%) met criteria for ICU admission (median age: 61 years [interquartile range (IQR), 49.5–71.5]; 35.1% female). Common comorbidities were hypertension (84; 64.1%), and diabetes (54; 41.2%). Of the 131 ICU patients, 109 (83.2%) required MV and 9 (6.9%) received ECMO. Lower positive end expiratory pressure (PEEP) were observed in survivors [9.2 (7.7–10.4)] vs non-survivors [10 (9.1–12.9] p = 0.004]. Compared to non-survivors, survivors had a longer MV length of stay (LOS) [14 (IQR 8–22) vs 8.5 (IQR 5–10.8) p< 0.001], Hospital LOS [21 (IQR 13–31) vs 10 (7–1) p< 0.001] and ICU LOS [14 (IQR 7–24) vs 9.5 (IQR 6–11), p < 0.001]. The overall hospital mortality and MV-related mortality were 19.8% and 23.8% respectively. After exclusion of hospitalized patients, the hospital and MV-related mortality rates were 21.6% and 26.5% respectively. Conclusions Our study demonstrates an important improvement in mortality of patients with severe COVID-19 who required ICU admission and MV in comparison to previous observational reports and emphasizes the importance of standard of care measures in the management of COVID-19.

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Noninvasive Versus Invasive Ventilation in COVID-19: One Size Does Not Fit All!

Cited by 22 publications

References 7 publications

Systemic Immune-Inflammatory Index predicts prognosis of patients with COVID-19: a retrospective study

Systemic Immune-Inflammatory Index predicts prognosis of patients with COVID-19: a retrospective study

Mortality of Patients With Severe COVID-19 in the Intensive Care Unit: An Observational Study From a Major COVID-19 Receiving Hospital

ICU outcomes and survival in patients with severe COVID-19 in the largest health care system in central Florida

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