1
|
Reyes LF, Murthy S, Garcia-Gallo E, Merson L, Ibáñez-Prada ED, Rello J, Fuentes YV, Martin-Loeches I, Bozza F, Duque S, Taccone FS, Fowler RA, Kartsonaki C, Gonçalves BP, Citarella BW, Aryal D, Burhan E, Cummings MJ, Delmas C, Diaz R, Figueiredo-Mello C, Hashmi M, Panda PK, Jiménez MP, Rincon DFB, Thomson D, Nichol A, Marshall JC, Olliaro PL. 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. Crit Care 2022; 26:276. [PMID: 36100904 PMCID: PMC9469080 DOI: 10.1186/s13054-022-04155-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/30/2022] [Indexed: 12/24/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Luis Felipe Reyes
- Pandemic Sciences Institute, University of Oxford, Oxford, UK.
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia.
- Critical Care Department, Clínica Universidad de La Sabana, Chía, Colombia.
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | | | - Laura Merson
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Elsa D Ibáñez-Prada
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia
- Critical Care Department, Clínica Universidad de La Sabana, Chía, Colombia
| | - Jordi Rello
- Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
- Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Yuli V Fuentes
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia
- Critical Care Department, Clínica Universidad de La Sabana, Chía, Colombia
| | - Ignacio Martin-Loeches
- Department of Clinical Medicine, St James's Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Ireland
| | - Fernando Bozza
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
- Brazilian Research in Intensive Care Network (BRICNet), Rio de Janeiro, Brazil
- Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Sara Duque
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia
| | - Fabio S Taccone
- Department of Intensive Care, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Laboratoire de Recherche Experimentale, Department of Intensive Care, Hôpital Erasme, Brussels, Belgium
| | - Robert A Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Erlina Burhan
- Infection Division, Department of Pulmonology and Respiratory Medicine, Universitas Indonesia, Depok, Indonesia
| | - Matthew J Cummings
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Rodrigo Diaz
- Intensive Care Unit, Clinica Las Condes, Santiago, Chile
| | | | - Madiha Hashmi
- Critical Care Asia and Ziauddin University, Karachi, Pakistan
| | | | | | | | - David Thomson
- Division of Critical Care, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Alistair Nichol
- University College Dublin Clinical Research Centre at St Vincent's University Hospital, Dublin, Ireland
| | - John C Marshall
- Li Ka Shing Knowledge Institute, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
| | - Piero L Olliaro
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | | |
Collapse
|