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Pisciotta W, Passannante A, Arina P, Alotaibi K, Ambler G, Arulkumaran N. High-flow nasal oxygen versus conventional oxygen therapy and noninvasive ventilation in COVID-19 respiratory failure: a systematic review and network meta-analysis of randomised controlled trials. Br J Anaesth 2024; 132:936-944. [PMID: 38307776 DOI: 10.1016/j.bja.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/17/2023] [Accepted: 12/18/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Noninvasive methods of respiratory support, including noninvasive ventilation (NIV), continuous positive airway pressure (CPAP), and high-flow nasal oxygen (HFNO), are potential strategies to prevent progression to requirement for invasive mechanical ventilation in acute hypoxaemic respiratory failure. The COVID-19 pandemic provided an opportunity to understand the utility of noninvasive respiratory support among a homogeneous cohort of patients with contemporary management of acute respiratory distress syndrome. We performed a network meta-analysis of studies evaluating the efficacy of NIV (including CPAP) and HFNO, compared with conventional oxygen therapy (COT), in patients with COVID-19. METHODS PubMed, Embase, and the Cochrane library were searched in May 2023. Standard random-effects meta-analysis was used first to estimate all direct pairwise associations and the results from all studies were combined using frequentist network meta-analysis. Primary outcome was treatment failure, defined as discontinuation of HFNO, NIV, or COT despite progressive disease. Secondary outcome was mortality. RESULTS We included data from eight RCTs with 2302 patients, (756 [33%] assigned to COT, 371 [16%] to NIV, and 1175 [51%] to HFNO). The odds of treatment failure were similar for NIV (P=0.33) and HFNO (P=0.25), and both were similar to that for COT (reference category). The odds of mortality were similar for all three treatments (odds ratio for NIV vs COT: 1.06 [0.46-2.44] and HFNO vs COT: 0.97 [0.57-1.65]). CONCLUSIONS Noninvasive ventilation, high-flow nasal oxygen, and conventional oxygen therapy are comparable with regards to treatment failure and mortality in COVID-19-associated acute respiratory failure. PROSPERO REGISTRATION CRD42023426495.
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Affiliation(s)
- Walter Pisciotta
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
| | - Alberto Passannante
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
| | - Pietro Arina
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
| | - Khalid Alotaibi
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Nishkantha Arulkumaran
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK.
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Beliero AM, Lázaro APP, Zaranza MDS, Lima GMC, Guimarães ÁR, Aragão NL, Meneses GC, Holanda MA, Albuquerque PLMM, da Silva GB, Fernandes PFCBC. ELMO CPAP: an innovative type of ventilatory support for COVID-19-related acute respiratory distress syndrome. J Bras Pneumol 2024; 49:e20230227. [PMID: 38232252 PMCID: PMC10769475 DOI: 10.36416/1806-3756/e20230227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/27/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE To assess whether the use of ELMO, a helmet for noninvasive ventilation created in Brazil, had a positive impact on the prognosis of patients with hypoxemic respiratory failure caused by severe COVID-19. METHODS This is a retrospective study of 50 critically ill COVID-19 patients. Epidemiological, clinical, and laboratory data were collected on ICU admission, as well as before, during, and after ELMO use. Patients were divided into two groups (success and failure) according to the outcome. RESULTS ELMO use improved oxygenation parameters such as Pao2, Fio2, and the Pao2/Fio2 ratio, and this contributed to a gradual reduction in Fio2, without an increase in CO2, as determined by arterial blood gas analysis. Patients in the success group had significantly longer survival (p < 0.001), as determined by the Kaplan-Meier analysis, less need for intubation (p < 0.001), fewer days of hospitalization, and a lower incidence of acute kidney injury in comparison with those in the failure group. CONCLUSIONS The significant improvement in oxygenation parameters, the longer survival, as reflected by the reduced need for intubation and by the mortality rate, and the absence of acute kidney injury suggest that the ELMO CPAP system is a promising tool for treating ARDS and similar clinical conditions.
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Affiliation(s)
- Andréa Mazza Beliero
- . Instituto Dr. José Frota, Prefeitura Municipal de Fortaleza, Fortaleza (CE) Brasil
- . Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade Estadual do Ceará, Fortaleza (CE) Brasil
| | - Ana Paula Pires Lázaro
- . Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
| | - Marza de Sousa Zaranza
- . Instituto Dr. José Frota, Prefeitura Municipal de Fortaleza, Fortaleza (CE) Brasil
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Giovanna Mazza Cruz Lima
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
| | - Álvaro Rolim Guimarães
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Nilcyeli Linhares Aragão
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Gdayllon Cavalcante Meneses
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Marcelo Alcantara Holanda
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
- . Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Polianna Lemos Moura Moreira Albuquerque
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
- . Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Geraldo Bezerra da Silva
- . Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
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Arabi YM, Al-Dorzi HM, Aldekhyl S, Al Qahtani S, Abdukahil SA, Al Qasim E, Al Harbi MK, Kharaba A, Albrahim T, Alshahrani MS, Al-Fares AA, Al Bshabshe A, Mady A, Al Duhailib Z, Algethamy H, Jose J, Al Mutairi M, Al Zumai O, Al Haji H, Alaqeily A, Al Wehaibi W, Al Aseri Z, Al-Omari A, Tlayjeh H, Al-Dawood A; Saudi Critical Care Trials Group. Long-term outcomes of patients with COVID-19 treated with helmet noninvasive ventilation or usual respiratory support: follow-up study of the Helmet-COVID randomized clinical trial. Intensive Care Med 2023; 49:302-12. [PMID: 36820878 DOI: 10.1007/s00134-023-06981-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/07/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To evaluate whether helmet noninvasive ventilation compared to usual respiratory support reduces 180-day mortality and improves health-related quality of life (HRQoL) in patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia. METHODS This is a pre-planned follow-up study of the Helmet-COVID trial. In this multicenter, randomized clinical trial, adults with acute hypoxemic respiratory failure (n = 320) due to coronavirus disease 2019 (COVID-19) were randomized to receive helmet noninvasive ventilation or usual respiratory support. The modified intention-to-treat population consisted of all enrolled patients except three who were lost at follow-up. The study outcomes were 180-day mortality, EuroQoL (EQ)-5D-5L index values, and EQ-visual analog scale (EQ-VAS). In the modified intention-to-treat analysis, non-survivors were assigned a value of 0 for EQ-5D-5L and EQ-VAS. RESULTS Within 180 days, 63/159 patients (39.6%) died in the helmet noninvasive ventilation group compared to 65/158 patients (41.1%) in the usual respiratory support group (risk difference - 1.5% (95% confidence interval [CI] - 12.3, 9.3, p = 0.78). In the modified intention-to-treat analysis, patients in the helmet noninvasive ventilation and the usual respiratory support groups did not differ in EQ-5D-5L index values (median 0.68 [IQR 0.00, 1.00], compared to 0.67 [IQR 0.00, 1.00], median difference 0.00 [95% CI - 0.32, 0.32; p = 0.91]) or EQ-VAS scores (median 70 [IQR 0, 93], compared to 70 [IQR 0, 90], median difference 0.00 (95% CI - 31.92, 31.92; p = 0.55). CONCLUSIONS Helmet noninvasive ventilation did not reduce 180-day mortality or improve HRQoL compared to usual respiratory support among patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia.
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Arabi YM, Aldekhyl S, Al Qahtani S, Al-Dorzi HM, Abdukahil SA, Al Harbi MK, Al Qasim E, Kharaba A, Albrahim T, Alshahrani MS, Al-Fares AA, Al Bshabshe A, Mady A, Al Duhailib Z, Algethamy H, Jose J, Al Mutairi M, Al Zumai O, Al Haji H, Alaqeily A, Al Aseri Z, Al-Omari A, Al-Dawood A, Tlayjeh H. Effect of Helmet Noninvasive Ventilation vs Usual Respiratory Support on Mortality Among Patients With Acute Hypoxemic Respiratory Failure Due to COVID-19: The HELMET-COVID Randomized Clinical Trial. JAMA 2022; 328:1063-1072. [PMID: 36125473 PMCID: PMC9490511 DOI: 10.1001/jama.2022.15599] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Helmet noninvasive ventilation has been used in patients with COVID-19 with the premise that helmet interface is more effective than mask interface in delivering prolonged treatments with high positive airway pressure, but data about its effectiveness are limited. OBJECTIVE To evaluate whether helmet noninvasive ventilation compared with usual respiratory support reduces mortality in patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia. DESIGN, SETTING, AND PARTICIPANTS This was a multicenter, pragmatic, randomized clinical trial that was conducted in 8 sites in Saudi Arabia and Kuwait between February 8, 2021, and November 16, 2021. Adult patients with acute hypoxemic respiratory failure (n = 320) due to suspected or confirmed COVID-19 were included. The final follow-up date for the primary outcome was December 14, 2021. INTERVENTIONS Patients were randomized to receive helmet noninvasive ventilation (n = 159) or usual respiratory support (n = 161), which included mask noninvasive ventilation, high-flow nasal oxygen, and standard oxygen. MAIN OUTCOMES AND MEASURES The primary outcome was 28-day all-cause mortality. There were 12 prespecified secondary outcomes, including endotracheal intubation, barotrauma, skin pressure injury, and serious adverse events. RESULTS Among 322 patients who were randomized, 320 were included in the primary analysis, all of whom completed the trial. Median age was 58 years, and 187 were men (58.4%). Within 28 days, 43 of 159 patients (27.0%) died in the helmet noninvasive ventilation group compared with 42 of 161 (26.1%) in the usual respiratory support group (risk difference, 1.0% [95% CI, -8.7% to 10.6%]; relative risk, 1.04 [95% CI, 0.72-1.49]; P = .85). Within 28 days, 75 of 159 patients (47.2%) required endotracheal intubation in the helmet noninvasive ventilation group compared with 81 of 161 (50.3%) in the usual respiratory support group (risk difference, -3.1% [95% CI, -14.1% to 7.8%]; relative risk, 0.94 [95% CI, 0.75-1.17]). There were no significant differences between the 2 groups in any of the prespecified secondary end points. Barotrauma occurred in 30 of 159 patients (18.9%) in the helmet noninvasive ventilation group and 25 of 161 (15.5%) in the usual respiratory support group. Skin pressure injury occurred in 5 of 159 patients (3.1%) in the helmet noninvasive ventilation group and 10 of 161 (6.2%) in the usual respiratory support group. There were 2 serious adverse events in the helmet noninvasive ventilation group and 1 in the usual respiratory support group. CONCLUSIONS AND RELEVANCE Results of this study suggest that helmet noninvasive ventilation did not significantly reduce 28-day mortality compared with usual respiratory support among patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia. However, interpretation of the findings is limited by imprecision in the effect estimate, which does not exclude potentially clinically important benefit or harm. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04477668.
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Affiliation(s)
- Yaseen M. Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Sara Aldekhyl
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Saad Al Qahtani
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Hasan M. Al-Dorzi
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Sheryl Ann Abdukahil
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Khulaif Al Harbi
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Department of Anesthesia, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Eman Al Qasim
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Ayman Kharaba
- Pulmonary and Critical Care Departments, King Fahad Hospital, Madinah, Kingdom of Saudi Arabia
| | - Talal Albrahim
- Department of Critical Care, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Kingdom of Saudi Arabia
| | - Mohammed S. Alshahrani
- Department of Emergency and Critical Care, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Kingdom of Saudi Arabia
| | - Abdulrahman A. Al-Fares
- Department of Anesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait, Kuwait
| | - Ali Al Bshabshe
- Department of Critical Care Medicine, King Khalid University, Aseer Central Hospital, Abha, Kingdom of Saudi Arabia
| | - Ahmed Mady
- Intensive Care Department, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
- College of Medicine, Tanta University, Tanta, Egypt
| | - Zainab Al Duhailib
- Adult Critical Care Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Haifa Algethamy
- Department of Anesthesia and Critical Care, King Abdulaziz University, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Jesna Jose
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Department of Bioinformatics and Biostatistics, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Al Mutairi
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Omar Al Zumai
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Hussain Al Haji
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed Alaqeily
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Zohair Al Aseri
- Emergency and Intensive Care Departments, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Awad Al-Omari
- Alfaisal University, Critical Care and Infectious Disease and Infection Control Departments, Dr Sulaiman Al Habib Medical Group, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaziz Al-Dawood
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Haytham Tlayjeh
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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Gasa M, Ruiz-Albert Y, Cordoba-Izquierdo A, Sarasate M, Cuevas E, Suarez-Cuartin G, Méndez L, Alfaro-Álvarez JC, Sabater-Riera J, Pérez-Fernández XL, Molina-Molina M, Santos S. Outcomes of COVID-19 Patients Admitted to the Intermediate Respiratory Care Unit: Non-Invasive Respiratory Therapy in a Sequential Protocol. Int J Environ Res Public Health 2022; 19:10772. [PMID: 36078488 PMCID: PMC9518070 DOI: 10.3390/ijerph191710772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
The intermediate respiratory care units (IRCUs) have a pivotal role managing escalation and de-escalation between the general wards and the intensive care units (ICUs). Since the COVID-19 pandemic began, the early detection of patients that could improve on non-invasive respiratory therapies (NRTs) in IRCUs without invasive approaches is crucial to ensure proper medical management and optimize limiting ICU resources. The aim of this study was to assess factors associated with survival, ICU admission and intubation likelihood in COVID-19 patients admitted to IRCUs. Observational retrospective study in consecutive patients admitted to the IRCU of a tertiary hospital from March 2020 to April 2021. Inclusion criteria: hypoxemic respiratory failure (SpO2 ≤ 94% and/or respiratory rate ≥ 25 rpm with FiO2 > 50% supplementary oxygen) due to acute COVID-19 infection. Demographic, comorbidities, clinical and analytical data, and medical and NRT data were collected at IRCU admission. Multivariate logistic regression models assessed factors associated with survival, ICU admission, and intubation. From 679 patients, 79 patients (12%) had an order to not do intubation. From the remaining 600 (88%), 81% survived, 41% needed ICU admission and 37% required intubation. In the IRCU, 51% required non-invasive ventilation (NIV group) and 49% did not (non-NIV group). Older age and lack of corticosteroid treatment were associated with higher mortality and intubation risk in the scheme, which could be more beneficial in severe forms. Initial NIV does not always mean worse outcomes.
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Affiliation(s)
- Mercè Gasa
- Respiratory Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (Y.R.-A.); (A.C.-I.); (M.S.); (E.C.); (G.S.-C.); (L.M.); (M.M.-M.)
- Department of Medicine, Campus Bellvitge, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain
| | - Yolanda Ruiz-Albert
- Respiratory Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (Y.R.-A.); (A.C.-I.); (M.S.); (E.C.); (G.S.-C.); (L.M.); (M.M.-M.)
| | - Ana Cordoba-Izquierdo
- Respiratory Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (Y.R.-A.); (A.C.-I.); (M.S.); (E.C.); (G.S.-C.); (L.M.); (M.M.-M.)
| | - Mikel Sarasate
- Respiratory Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (Y.R.-A.); (A.C.-I.); (M.S.); (E.C.); (G.S.-C.); (L.M.); (M.M.-M.)
| | - Ester Cuevas
- Respiratory Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (Y.R.-A.); (A.C.-I.); (M.S.); (E.C.); (G.S.-C.); (L.M.); (M.M.-M.)
| | - Guillermo Suarez-Cuartin
- Respiratory Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (Y.R.-A.); (A.C.-I.); (M.S.); (E.C.); (G.S.-C.); (L.M.); (M.M.-M.)
| | - Lidia Méndez
- Respiratory Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (Y.R.-A.); (A.C.-I.); (M.S.); (E.C.); (G.S.-C.); (L.M.); (M.M.-M.)
| | | | - Joan Sabater-Riera
- Critical Care Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (J.S.-R.); (X.L.P.-F.)
| | - Xosé L. Pérez-Fernández
- Critical Care Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (J.S.-R.); (X.L.P.-F.)
| | - María Molina-Molina
- Respiratory Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (Y.R.-A.); (A.C.-I.); (M.S.); (E.C.); (G.S.-C.); (L.M.); (M.M.-M.)
- Department of Medicine, Campus Bellvitge, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain
| | - Salud Santos
- Respiratory Department, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain; (Y.R.-A.); (A.C.-I.); (M.S.); (E.C.); (G.S.-C.); (L.M.); (M.M.-M.)
- Department of Medicine, Campus Bellvitge, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain
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