Very late intubation in COVID-19 patients: a forgotten prognosis factor?

Camous, Laurent; Pommier, Jean-David; Martino, Frédéric; Tressières, Benoît; Demoule, Alexandre; Valette, Marc

doi:10.1186/s13054-022-03966-6

Cited by 15 publications

(10 citation statements)

References 6 publications

(10 reference statements)

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“…In these studies, the mortality was 66.5% in patients treated by IMV after failure of non-invasive ventilation [26] and 87% in very late IMV following steroid treatment. [27] The combined mortality of patients treated by IMV after CPAP failure in the present and our previous studies was 37.5%, which is also less than the 53.5% reported for primary [26] and 53% for early [27] IMV. Moreover, the length of CPAP treatment was not a risk factor for mortality.…”

Section: Discussioncontrasting

confidence: 61%

“…In our studies, the Venturi generators were adapted to guarantee flows that were presumably higher than patients' peak inspiratory flows and strict intubation criteria were followed including PaO 2 , which is the most reliable measurement of patient's oxygenation. [25] The possibility of detrimental effects of non-invasive ventilation or high-flow nasal oxygen by delaying intubation in COVID-19 patients has been recently raised [26,27]. In these studies, the mortality was 66.5% in patients treated by IMV after failure of non-invasive ventilation [26] and 87% in very late IMV following steroid treatment.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The use of continuous positive airway pressure during the second and third waves of the COVID-19 pandemic

Brusasco

Corradi²,

Dazzi³

et al. 2022

ERJ Open Res

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BackgroundIn a preliminary study during the first COVID-19 pandemic wave, we reported a high rate of success with continuous positive airway pressure (CPAP) in preventing death and invasive mechanical ventilation (IMV). That study, however, was too small to identify risk factors for mortality, barotrauma and impact on subsequent IMV. Thus, we re-evaluated the efficacy of the same CPAP protocol in a larger series of patients during second and third pandemic waves.Methods281 COVID-19 patients with moderate-to-severe acute hypoxemic respiratory failure (158 full-code and 123 do-not-intubate, DNI), were managed with high-flow CPAP early in their hospitalization. IMV was considered after 4 days of unsuccessful CPAP.ResultsThe overall recovery rate from respiratory failure was 50% in the DNI and 89% in the full-code group. Among the latter, 71% recovered with CPAP only, 3% died under CPAP and 26% were intubated after a median CPAP time of 7 days (IQR: 5–12 days). Of the patients who were intubated, 68% recovered and were discharged from the hospital within 28 days. Barotrauma occurred during CPAP in <4% of patients. Age (OR=1.128; p <0.001) and tomographic severity score (OR=1.139; p=0.006) were the only independent predictors of mortalityConclusionsEarly treatment with CPAP is a safe option for patients with acute hypoxemic respiratory failure due to COVID-19.

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

The use of continuous positive airway pressure during the second and third waves of the COVID-19 pandemic

Brusasco

Corradi²,

Dazzi³

et al. 2022

ERJ Open Res

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“…Therefore, along with PaO 2 , PaO 2 /FiO 2 ratio, and (A-a) O 2 gradient, we decided to include mROX as a further marker of response to CPAP. In fact, mROX has been proposed as a superior predictor of clinical outcomes compared to the ROX index in patients with acute respiratory failure treated with HFNC [ 7 ] or CPAP [ 33 ] and reflects the possible reduction of respiratory rate induced by CPAP in patients with respiratory distress.…”

Section: Discussionmentioning

confidence: 99%

Acute Improvements of Oxygenation with Cpap and Clinical Outcomes in Severe COVID-19 Pneumonia: A Multicenter, Retrospective Study

Pini

Radovanovic

Saad

et al. 2022

JCM

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It is not known if the degrees of improvement in oxygenation obtained by CPAP can predict clinical outcomes in patients with COVID-19 pneumonia. This was a retrospective study conducted on patients with severe COVID-19 pneumonia treated with CPAP in three University hospitals in Milan, Italy, from March 2020 to March 2021. Arterial gas analysis was obtained before and 1 h after starting CPAP. CPAP failure included either death in the respiratory units while on CPAP or the need for intubation. Two hundred and eleven patients (mean age 64 years, 74% males) were included. Baseline median PaO2, PaO2/FiO2 ratio (P/F), and the alveolar-arterial (A-a) O2 gradient were 68 (57–83) mmHg, 129 (91–179) mmHg and 310 (177–559) mmHg, respectively. Forty-two (19.9%) patients died in the respiratory units and 51 (24.2%) were intubated. After starting CPAP, PaO2/FiO2 increased by 57 (12–113; p < 0.001) mmHg, and (A-a) O2 was reduced by 68 (−25–250; p < 0.001) mmHg. A substantial overlap of PaO2, P/F, and A-a gradient at baseline and during CPAP was observed in CPAP failures and successes; CPAP-associated improvements in oxygenation in both groups were similar. In conclusion, CPAP-associated improvements in oxygenation do not predict clinical outcomes in patients with severe COVID-19 pneumonia.

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“…We have read the manuscript published by Camous and colleagues in this journal [ 1 ]. We want to congratulate the authors for their effort in describing outcomes in ventilated COVID-19 patients and its relationship to the time of intubation.…”

mentioning

confidence: 99%

Comment to “Very late intubation in COVID-19 patients: A forgotten prognosis factor?”

Artigas

Zattera²,

Barbeta

et al. 2022

Crit Care

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Very late intubation in COVID-19 patients: a forgotten prognosis factor?

Cited by 15 publications

References 6 publications

The use of continuous positive airway pressure during the second and third waves of the COVID-19 pandemic

The use of continuous positive airway pressure during the second and third waves of the COVID-19 pandemic

Acute Improvements of Oxygenation with Cpap and Clinical Outcomes in Severe COVID-19 Pneumonia: A Multicenter, Retrospective Study

Comment to “Very late intubation in COVID-19 patients: A forgotten prognosis factor?”

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