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
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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. / Reyes, Luis Felipe; Murthy, Srinivas; Garcia-Gallo, Esteban; Merson, Laura; Ibáñez-Prada, Elsa D; Rello, Jordi; Fuentes, Yuli V; Martin-Loeches, Ignacio; Bozza, Fernando; Duque, Sara; Taccone, Fabio S; Fowler, Robert A; Kartsonaki, Christiana; Gonçalves, Bronner P; Citarella, Barbara Wanjiru; Aryal, Diptesh; Burhan, Erlina; Cummings, Matthew J; Delmas, Christelle; Diaz, Rodrigo; Figueiredo-Mello, Claudia; Hashmi, Madiha; Panda, Prasan Kumar; Jiménez, Miguel Pedrera; Rincon, Diego Fernando Bautista; Thomson, David; Nichol, Alistair; Marshall, John C; Olliaro, Piero L; ISARIC Characterization Group.
in: CRIT CARE, Jahrgang 26, Nr. 1, 13.09.2022, S. 276.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - 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
AU - Reyes, Luis Felipe
AU - Murthy, Srinivas
AU - Garcia-Gallo, Esteban
AU - Merson, Laura
AU - Ibáñez-Prada, Elsa D
AU - Rello, Jordi
AU - Fuentes, Yuli V
AU - Martin-Loeches, Ignacio
AU - Bozza, Fernando
AU - Duque, Sara
AU - Taccone, Fabio S
AU - Fowler, Robert A
AU - Kartsonaki, Christiana
AU - Gonçalves, Bronner P
AU - Citarella, Barbara Wanjiru
AU - Aryal, Diptesh
AU - Burhan, Erlina
AU - Cummings, Matthew J
AU - Delmas, Christelle
AU - Diaz, Rodrigo
AU - Figueiredo-Mello, Claudia
AU - Hashmi, Madiha
AU - Panda, Prasan Kumar
AU - Jiménez, Miguel Pedrera
AU - Rincon, Diego Fernando Bautista
AU - Thomson, David
AU - Nichol, Alistair
AU - Marshall, John C
AU - Olliaro, Piero L
AU - ISARIC Characterization Group
AU - Kobbe, Robin
N1 - © 2022. The Author(s).
PY - 2022/9/13
Y1 - 2022/9/13
N2 - 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.
AB - 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.
KW - COVID-19/therapy
KW - Humans
KW - Prospective Studies
KW - Respiratory Insufficiency/therapy
KW - SARS-CoV-2
KW - Tachypnea
U2 - 10.1186/s13054-022-04155-1
DO - 10.1186/s13054-022-04155-1
M3 - SCORING: Journal article
C2 - 36100904
VL - 26
SP - 276
JO - CRIT CARE
JF - CRIT CARE
SN - 1364-8535
IS - 1
ER -