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Wendel Garcia PD, Aguirre-Bermeo H, Buehler PK, Alfaro-Farias M, Yuen B, David S, Tschoellitsch T, Wengenmayer T, Korsos A, Fogagnolo A, Kleger GR, Wu MA, Colombo R, Turrini F, Potalivo A, Rezoagli E, Rodríguez-García R, Castro P, Lander-Azcona A, Martín-Delgado MC, Lozano-Gómez H, Ensner R, Michot MP, Gehring N, Schott P, Siegemund M, Merki L, Wiegand J, Jeitziner MM, Laube M, Salomon P, Hillgaertner F, Dullenkopf A, Ksouri H, Cereghetti S, Grazioli S, Bürkle C, Marrel J, Fleisch I, Perez MH, Baltussen Weber A, Ceruti S, Marquardt K, Hübner T, Redecker H, Studhalter M, Stephan M, Selz D, Pietsch U, Ristic A, Heise A, Meyer Zu Bentrup F, Franchitti Laurent M, Fodor P, Gaspert T, Haberthuer C, Colak E, Heuberger DM, Fumeaux T, Montomoli J, Guerci P, Schuepbach RA, Hilty MP, Roche-Campo F. Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort. Crit Care 2021; 25:175. [PMID: 34034782 PMCID: PMC8146172 DOI: 10.1186/s13054-021-03580-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/15/2021] [Indexed: 12/31/2022]
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.
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Affiliation(s)
- Pedro D Wendel Garcia
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.,The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland
| | | | - Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Mario Alfaro-Farias
- Unidad de Cuidados Intensivos, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
| | - Bernd Yuen
- Interdisziplinaere Intensivstation, Spital Buelach, Buelach, Switzerland
| | - Sascha David
- Department of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany
| | - Thomas Tschoellitsch
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH and Johannes Kepler University, Linz, Austria
| | - Tobias Wengenmayer
- Department of Medicine III - Interdisciplinary Medical Intensive Care, Medical Center University of Freiburg, Freiburg, Germany
| | - Anita Korsos
- Departement of Anaethesiology and Intensive Care, University of Szeged, Szeged, Hungary
| | - Alberto Fogagnolo
- Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Gian-Reto Kleger
- Medizinische Intensivstation, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Maddalena A Wu
- Department of Internal Medicine, ASST Fatebenefratelli Sacco - "Luigi Sacco" Hospital, Milan, Italy
| | - Riccardo Colombo
- Division of Anesthesia and Intensive Care, ASST Fatebenefratelli Sacco - "Luigi Sacco" Hospital, Milan, Italy
| | - Fabrizio Turrini
- Internal Medicine, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | | | - Emanuele Rezoagli
- Department of Anesthesia and Intensive Care Medicine, Policlinico San Marco, Gruppo Ospedaliero San Donato, Bergamo, Italy
| | - Raquel Rodríguez-García
- Servicio de Medicina intensiva, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | - Herminia Lozano-Gómez
- Unidad de Cuidados Intensivos, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Rolf Ensner
- Klinik für Operative Intensivmedizin, Kantonsspital Aarau, Aarau, Switzerland
| | - Marc P Michot
- Medizinische Intensivstation, Kantonsspital Aarau, Aarau, Switzerland
| | - Nadine Gehring
- Intensivstation, Kantonsspital Schaffhausen, Schaffhausen, Switzerland
| | - Peter Schott
- Institut fuer Anesthaesie und Intensivmedizin, Zuger Kantonsspital AG, Baar, Switzerland
| | - Martin Siegemund
- Department Intensivmedizin, Universitaetsspital Basel, Basel, Switzerland
| | - Lukas Merki
- Intensivmedizin, St. Claraspital, Basel, Switzerland
| | - Jan Wiegand
- Interdisziplinaere Intensivmedizin, Lindenhofspital, Bern, Switzerland
| | - Marie M Jeitziner
- Department of Intensive Care Medicine, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Marcus Laube
- Department Intensive Care Medicine, Spitalzentrum Biel, Biel, Switzerland
| | - Petra Salomon
- Intensivstation, Regionalspital Emmental AG, Burgdorf, Switzerland
| | | | - Alexander Dullenkopf
- Institut fuer Anaesthesie und Intensivmedizin, Spital Thurgau, Frauenfeld, Switzerland
| | - Hatem Ksouri
- Soins Intensifs, Hopital cantonal de Fribourg, Fribourg, Switzerland
| | - Sara Cereghetti
- Division of Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
| | - Serge Grazioli
- Division of Neonatal and Pediatric Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Julien Marrel
- Institut für Anaesthesiologie Intensivmedizin & Rettungsmedizin, See-Spital Horgen & Kilchberg, Horgen, Switzerland
| | - Isabelle Fleisch
- Soins Intensifs, Hirslanden Clinique Cecil, Lausanne, Switzerland
| | - Marie-Helene Perez
- Pediatric Intensive Care Unit, University Hospital Lausanne, Lausanne, Switzerland
| | | | - Samuele Ceruti
- Dipartimento Area Critica, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Katharina Marquardt
- Interdisziplinaere Intensivstation, Spital Maennedorf AG, Maennedorf, Switzerland
| | - Tobias Hübner
- Institut fuer Anaesthesie und Intensivmedizin, Spital Thurgau, Muensterlingen, Switzerland
| | - Hermann Redecker
- Intensivmedizin, Schweizer Paraplegikerzentrum Nottwil, Nottwil, Switzerland
| | - Michael Studhalter
- Intensivmedizin & Intermediate Care, Kantonsspital Olten, Olten, Switzerland
| | | | - Daniela Selz
- Anaesthesie Intensivmedizin Schmerzmedizin, Spital Schwyz, Schwyz, Switzerland
| | - Urs Pietsch
- Departement of Anesthesiology and Intensive Care Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Anette Ristic
- Departement for Intensive Care Medicine, Kantonsspital Nidwalden, Stans, Switzerland
| | - Antje Heise
- Intensivstation, Spital Simmental-Thun-Saanenland AG, Thun, Switzerland
| | | | | | - Patricia Fodor
- Interdisziplinaere Intensivstation, Stadtspital Triemli, Zurich, Switzerland
| | - Tomislav Gaspert
- Abteilung für Anaesthesiologie und Intensivmedizin, Hirslanden Klinik Im Park, Zurich, Switzerland
| | - Christoph Haberthuer
- Institut für Anaesthesiologie und Intensivmedizin, Klinik Hirslanden, Zurich, Switzerland
| | - Elif Colak
- General Surgery, Samsun Training and Research Hospital, Samsun, Turkey
| | - Dorothea M Heuberger
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Thierry Fumeaux
- The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland.,Soins intensifs, Groupement Hospitalier de l'Ouest Lémanique, Hôpital de Nyon, Nyon, Switzerland
| | - Jonathan Montomoli
- The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland.,Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Philippe Guerci
- The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland.,Department of Anesthesiology and Critical Care Medicine, University Hospital of Nancy, Nancy, France
| | - Reto A Schuepbach
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.,The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland
| | - Matthias P Hilty
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.,The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland
| | - Ferran Roche-Campo
- Servicio de Medicina intensiva, Hospital Verge de la Cinta, Carrer de les Esplanetes 44, 43500, Tortosa, Tarragona, Spain.
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