Pedro D Wendel Garcia1,2, Hernán Aguirre-Bermeo3, Philipp K Buehler1, Mario Alfaro-Farias4, Bernd Yuen5, Sascha David6, Thomas Tschoellitsch7, Tobias Wengenmayer8, Anita Korsos9, Alberto Fogagnolo10, Gian-Reto Kleger11, Maddalena A Wu12, Riccardo Colombo13, Fabrizio Turrini14, Antonella Potalivo15, Emanuele Rezoagli16, Raquel Rodríguez-García17, Pedro Castro18, Arantxa Lander-Azcona19, Maria C Martín-Delgado20, Herminia Lozano-Gómez21, Rolf Ensner22, Marc P Michot23, Nadine Gehring24, Peter Schott25, Martin Siegemund26, Lukas Merki27, Jan Wiegand28, Marie M Jeitziner29, Marcus Laube30, Petra Salomon31, Frank Hillgaertner32, Alexander Dullenkopf33, Hatem Ksouri34, Sara Cereghetti35, Serge Grazioli36, Christian Bürkle37, Julien Marrel38, Isabelle Fleisch39, Marie-Helene Perez40, Anja Baltussen Weber41, Samuele Ceruti42, Katharina Marquardt43, Tobias Hübner44, Hermann Redecker45, Michael Studhalter46, Michael Stephan47, Daniela Selz48, Urs Pietsch49, Anette Ristic50, Antje Heise51, Friederike Meyer Zu Bentrup52, Marilene Franchitti Laurent53, Patricia Fodor54, Tomislav Gaspert55, Christoph Haberthuer56, Elif Colak57, Dorothea M Heuberger1, Thierry Fumeaux2,58, Jonathan Montomoli2,59, Philippe Guerci2,60, Reto A Schuepbach1,2, Matthias P Hilty1,2, Ferran Roche-Campo61. 1. Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland. 2. The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland. 3. Unidad de Cuidados Intensivos, Hospital Vicente Corral Moscoso, Cuenca, Ecuador. 4. Unidad de Cuidados Intensivos, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra. 5. Interdisziplinaere Intensivstation, Spital Buelach, Buelach, Switzerland. 6. Department of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany. 7. Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH and Johannes Kepler University, Linz, Austria. 8. Department of Medicine III - Interdisciplinary Medical Intensive Care, Medical Center University of Freiburg, Freiburg, Germany. 9. Departement of Anaethesiology and Intensive Care, University of Szeged, Szeged, Hungary. 10. Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy. 11. Medizinische Intensivstation, Kantonsspital St. Gallen, St. Gallen, Switzerland. 12. Department of Internal Medicine, ASST Fatebenefratelli Sacco - "Luigi Sacco" Hospital, Milan, Italy. 13. Division of Anesthesia and Intensive Care, ASST Fatebenefratelli Sacco - "Luigi Sacco" Hospital, Milan, Italy. 14. Internal Medicine, Azienda Ospedaliera Universitaria di Modena, Modena, Italy. 15. UOC Anestesia e Rianimazione, Ospedale Infermi, Rimini, Italy. 16. Department of Anesthesia and Intensive Care Medicine, Policlinico San Marco, Gruppo Ospedaliero San Donato, Bergamo, Italy. 17. Servicio de Medicina intensiva, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain. 18. Medical Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain. 19. Servicio de Medicina Intensiva, Hospital General San Jorge, Huesca, Spain. 20. Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid, Spain. 21. Unidad de Cuidados Intensivos, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain. 22. Klinik für Operative Intensivmedizin, Kantonsspital Aarau, Aarau, Switzerland. 23. Medizinische Intensivstation, Kantonsspital Aarau, Aarau, Switzerland. 24. Intensivstation, Kantonsspital Schaffhausen, Schaffhausen, Switzerland. 25. Institut fuer Anesthaesie und Intensivmedizin, Zuger Kantonsspital AG, Baar, Switzerland. 26. Department Intensivmedizin, Universitaetsspital Basel, Basel, Switzerland. 27. Intensivmedizin, St. Claraspital, Basel, Switzerland. 28. Interdisziplinaere Intensivmedizin, Lindenhofspital, Bern, Switzerland. 29. Department of Intensive Care Medicine, University Hospital Bern, Inselspital, Bern, Switzerland. 30. Department Intensive Care Medicine, Spitalzentrum Biel, Biel, Switzerland. 31. Intensivstation, Regionalspital Emmental AG, Burgdorf, Switzerland. 32. Intensivmedizin, Kantonsspital Graubuenden, Chur, Switzerland. 33. Institut fuer Anaesthesie und Intensivmedizin, Spital Thurgau, Frauenfeld, Switzerland. 34. Soins Intensifs, Hopital cantonal de Fribourg, Fribourg, Switzerland. 35. Division of Intensive Care, University Hospitals of Geneva, Geneva, Switzerland. 36. Division of Neonatal and Pediatric Intensive Care, University Hospitals of Geneva, Geneva, Switzerland. 37. Intensivstation, Spital Grabs, Grabs, Switzerland. 38. Institut für Anaesthesiologie Intensivmedizin & Rettungsmedizin, See-Spital Horgen & Kilchberg, Horgen, Switzerland. 39. Soins Intensifs, Hirslanden Clinique Cecil, Lausanne, Switzerland. 40. Pediatric Intensive Care Unit, University Hospital Lausanne, Lausanne, Switzerland. 41. Anaesthesie und Intensivmedizin, Kantonsspital Baselland, Liestal, Switzerland. 42. Dipartimento Area Critica, Clinica Luganese Moncucco, Lugano, Switzerland. 43. Interdisziplinaere Intensivstation, Spital Maennedorf AG, Maennedorf, Switzerland. 44. Institut fuer Anaesthesie und Intensivmedizin, Spital Thurgau, Muensterlingen, Switzerland. 45. Intensivmedizin, Schweizer Paraplegikerzentrum Nottwil, Nottwil, Switzerland. 46. Intensivmedizin & Intermediate Care, Kantonsspital Olten, Olten, Switzerland. 47. Intensivmedizin, Spital Oberengadin, Samedan, Switzerland. 48. Anaesthesie Intensivmedizin Schmerzmedizin, Spital Schwyz, Schwyz, Switzerland. 49. Departement of Anesthesiology and Intensive Care Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland. 50. Departement for Intensive Care Medicine, Kantonsspital Nidwalden, Stans, Switzerland. 51. Intensivstation, Spital Simmental-Thun-Saanenland AG, Thun, Switzerland. 52. Klinik für Anaesthesie und Intensivmedizin, Spitalzentrum Oberwallis, Visp, Switzerland. 53. Service d'Anesthesiologie, EHNV, Yverdon-les-Bains, Switzerland. 54. Interdisziplinaere Intensivstation, Stadtspital Triemli, Zurich, Switzerland. 55. Abteilung für Anaesthesiologie und Intensivmedizin, Hirslanden Klinik Im Park, Zurich, Switzerland. 56. Institut für Anaesthesiologie und Intensivmedizin, Klinik Hirslanden, Zurich, Switzerland. 57. General Surgery, Samsun Training and Research Hospital, Samsun, Turkey. 58. Soins intensifs, Groupement Hospitalier de l'Ouest Lémanique, Hôpital de Nyon, Nyon, Switzerland. 59. Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, Netherlands. 60. Department of Anesthesiology and Critical Care Medicine, University Hospital of Nancy, Nancy, France. 61. Servicio de Medicina intensiva, Hospital Verge de la Cinta, Carrer de les Esplanetes 44, 43500, Tortosa, Tarragona, Spain. ferranroche@gmail.com.
Abstract
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.
BACKGROUND: Uncertainty about the optimal respiratory support strategies in critically illCOVID-19patients 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 illCOVID-19patients. 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 illpatients 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.
Authors: Wiebke Brücker; Amir Abbas Mahabadi; Annette Hüschen; Jan Becker; Sebastian Daehnke; Stefan Möhlenkamp Journal: J Thorac Dis Date: 2022-05 Impact factor: 3.005
Authors: Pedro David Wendel-Garcia; André Moser; Yok-Ai Que; Matthias Peter Hilty; Marie-Madlen Jeitziner; Hernán Aguirre-Bermeo; Pedro Arias-Sanchez; Janina Apolo; Ferran Roche-Campo; Diego Franch-Llasat; Gian-Reto Kleger; Claudia Schrag; Urs Pietsch; Miodrag Filipovic; Sascha David; Klaus Stahl; Souad Bouaoud; Amel Ouyahia; Patricia Fodor; Pascal Locher; Martin Siegemund; Nuria Zellweger; Sara Cereghetti; Peter Schott; Gianfilippo Gangitano; Maddalena Alessandra Wu; Mario Alfaro-Farias; Gerardo Vizmanos-Lamotte; Hatem Ksouri; Nadine Gehring; Emanuele Rezoagli; Fabrizio Turrini; Herminia Lozano-Gómez; Andrea Carsetti; Raquel Rodríguez-García; Bernd Yuen; Anja Baltussen Weber; Pedro Castro; Jesus Oscar Escos-Orta; Alexander Dullenkopf; Maria C Martín-Delgado; Theodoros Aslanidis; Marie-Helene Perez; Frank Hillgaertner; Samuele Ceruti; Marilene Franchitti Laurent; Julien Marrel; Riccardo Colombo; Marcus Laube; Alberto Fogagnolo; Michael Studhalter; Tobias Wengenmayer; Emiliano Gamberini; Christian Buerkle; Philipp K Buehler; Stefanie Keiser; Muhammed Elhadi; Jonathan Montomoli; Philippe Guerci; Thierry Fumeaux; Reto A Schuepbach; Stephan M Jakob Journal: Crit Care Date: 2022-07-04 Impact factor: 19.334
Authors: Faryal Khamis; Salah Al Awaidy; Muna Al Shaaibi; Mubarak Al Shukeili; Shabnam Chhetri; Afra Al Balushi; Sumaiya Al Sulaimi; Amal Al Balushi; Ronald Wesonga Journal: Diseases Date: 2021-12-23
Authors: Pedro David Wendel-Garcia; Jordi Mancebo; Arantxa Mas; Cristina González-Isern; Ricard Ferrer; Rafael Máñez; Joan-Ramon Masclans; Elena Sandoval; Paula Vera; Josep Trenado; Rafael Fernández; Josep-Maria Sirvent; Melcior Martínez; Mercedes Ibarz; Pau Garro; José Luis Lopera; María Bodí; Joan Carles Yébenes-Reyes; Carles Triginer; Imma Vallverdú; Anna Baró; Fernanda Bodí; Paula Saludes; Mauricio Valencia; Ferran Roche-Campo; Arturo Huerta; Francisco José Cambra; Carme Barberà; Jorge Echevarria; Óscar Peñuelas Journal: Crit Care Date: 2022-02-08 Impact factor: 9.097