Outcomes of COVID-19 Patients Intubated After Failure of Non-Invasive Ventilation: A Multicenter Observational Study.

Boscolo, Annalisa; Pasin, Laura; Sella, Nicolò; Pretto, Chiara; Tocco, Martina; Tamburini, Enrico; Rosi, Paolo; Polati, Enrico; Donadello, Katia; Gottin, Leonardo; Vianello, Andrea; Landoni, Giovanni; Navalesi, Paolo

doi:10.21203/rs.3.rs-400059/v1

Cited by 7 publications

(8 citation statements)

References 13 publications

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“…Also, they found that patients who failed NIV had higher mortality than those treated with IMV as initial treatment (38.4 vs 31.3, p = 0.18). In a multicentre COVID-19 study, Boscolo A. et al found that 704 patients who failed non-invasive respiratory support had an accumulative fatality rate of 43% [28]. Our findings support that patients with severe COVID-19 who fail the initial respiratory support with non-invasive treatments have a higher mortality rate and were independently associated with 28-day fatality.…”

Section: Discussionsupporting

confidence: 81%

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

et al. 2022

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Background Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable.

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Section: Discussionsupporting

confidence: 81%

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

et al. 2022

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“…After screening by abstract and title, 571 articles were selected for full-text assessment. In total, 157 studies evaluating 948,309 patients were included in the meta-analysis (9–159). The characteristics of all the included studies are shown in Table S1 (http://links.lww.com/CCX/B152).…”

Section: Resultsmentioning

confidence: 99%

Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis

Chandel

Leazer

Alcover

et al. 2023

Critical Care Explorations

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OBJECTIVES:To perform a systematic review and meta-analysis to generate estimates of mortality in patients with COVID-19 that required hospitalization, ICU admission, and organ support.DATA SOURCES: A systematic search of PubMed, Embase, and the Cochrane databases was conducted up to December 31, 2021.STUDY SELECTION: Previously peer-reviewed observational studies that reported ICU, mechanical ventilation (MV), renal replacement therapy (RRT) or extracorporeal membrane oxygenation (ECMO)-related mortality among greater than or equal to 100 individual patients.DATA EXTRACTION: Random-effects meta-analysis was used to generate pooled estimates of case fatality rates (CFRs) for in-hospital, ICU, MV, RRT, and ECMO-related mortality. ICU-related mortality was additionally analyzed by the study country of origin. Sensitivity analyses of CFR were assessed based on completeness of follow-up data, by year, and when only studies judged to be of high quality were included.

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“…It is worth noting that invasive ventilation represents the most severe phase of the disease, since it is an advanced treatment modality for severe hypoxemia [39][40][41] . In our Amazon region resources are limited regarding technologies for other non-invasive ventilation alternatives in the treatment of COVID-19 are used in other www.nature.com/scientificreports/ www.nature.com/scientificreports/ countries 42 .…”

Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of severe COVID-19 in hospitalized patients with cardiovascular diseases in the Amazonian region of Brazil: a retrospective cohort

Sardinha

Sá

Rodrigues

et al. 2022

Sci Rep

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The northern region of Brazil is already vulnerable to other infectious diseases and it was no different in COVID-19. However, cardiovascular diseases still lead the causes of death. Thus, the objective of this study is to identify the clinical predictors and outcome of severe COVID-19 in hospitalized patients with and without CVD in this region of the Amazon. A retrospective cohort, referring to the notifications from January 1 to December 31, 2020, including cases confirmed by molecular testing. The study consisted of 9223 confirmed cases for COVID-19. Of these, 6011 (65.17%) did not have cardiovascular disease and 3212 (34.83%) had some cardiovascular disease. The significance of deaths was in the age group of < 1 to 59 CVD carriers (< 0.001). Predictor of mortality were invasive ventilation for patients with CVD, (OR 23,688 CI 18,180–30,866), followed by chronic kidney disease (OR 2442 CI 1568–3740), dyspnea (OR 2312 CI 1817–3941), respiratory distress (OR 1523 CI 1210–2919), cough (OR 1268 CI 1005–1599), Lower oxygen saturation 95% (OR 1281 CI 1039–1579), diabetes mellitus (OR 1267 CI 1050–1528) and age (OR 1051 CI 1044–1058). Carriers of CVD had a lower survival rate (< 0.0001). The order of the predictors of death differed among the non-carriers, as well as the high odds ratio in the predictors of CVD, only cough was an independent predictor. The age group under 59 years was associated with deaths. We also show the shorter survival in CVD carriers, as well as the higher cardiovascular morbidity rate than other studies in the literature.

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Outcomes of COVID-19 Patients Intubated After Failure of Non-Invasive Ventilation: A Multicenter Observational Study.

Cited by 7 publications

References 13 publications

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis

Characteristics and outcomes of severe COVID-19 in hospitalized patients with cardiovascular diseases in the Amazonian region of Brazil: a retrospective cohort

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