tetano
Editor, Senior Moderator
BMC Anesthesiol
. 2021 May 20;21(1):155.
doi: 10.1186/s12871-021-01376-9.
The repurposed use of anesthesia machines to ventilate critically ill patients with coronavirus disease 2019 (COVID-19)
Maurizio Bottiroli[SUP] 1 [/SUP], Angelo Calini[SUP] 2 [/SUP], Riccardo Pinciroli[SUP] 3 [/SUP], Ariel Mueller[SUP] 3 [/SUP], Antonio Siragusa[SUP] 2 4 [/SUP], Carlo Anelli[SUP] 2 [/SUP], Richard D Urman[SUP] 5 [/SUP], Ala Nozari[SUP] 6 [/SUP], Lorenzo Berra[SUP] 3 [/SUP], Michele Mondino[SUP] 2 [/SUP], Roberto Fumagalli[SUP] 2 4 [/SUP]
Affiliations
Abstract
Background: The surge of critically ill patients due to the coronavirus disease-2019 (COVID-19) overwhelmed critical care capacity in areas of northern Italy. Anesthesia machines have been used as alternatives to traditional ICU mechanical ventilators. However, the outcomes for patients with COVID-19 respiratory failure cared for with Anesthesia Machines is currently unknow. We hypothesized that COVID-19 patients receiving care with Anesthesia Machines would have worse outcomes compared to standard practice.
Methods: We designed a retrospective study of patients admitted with a confirmed COVID-19 diagnosis at a large tertiary urban hospital in northern Italy. Two care units were included: a 27-bed standard ICU and a 15-bed temporary unit emergently opened in an operating room setting. Intubated patients assigned to Anesthesia Machines (AM group) were compared to a control cohort treated with standard mechanical ventilators (ICU-VENT group). Outcomes were assessed at 60-day follow-up. A multivariable Cox regression analysis of risk factors between survivors and non-survivors was conducted to determine the adjusted risk of death for patients assigned to AM group.
Results: Complete daily data from 89 mechanically ventilated patients consecutively admitted to the two units were analyzed. Seventeen patients were included in the AM group, whereas 72 were in the ICU-VENT group. Disease severity and intensity of treatment were comparable between the two groups. The 60-day mortality was significantly higher in the AM group compared to the ICU-vent group (12/17 vs. 27/72, 70.6% vs. 37.5%, respectively, p = 0.016). Allocation to AM group was associated with a significantly increased risk of death after adjusting for covariates (HR 4.05, 95% CI: 1.75-9.33, p = 0.001). Several incidents and complications were reported with Anesthesia Machine care, raising safety concerns.
Conclusions: Our results support the hypothesis that care associated with the use of Anesthesia Machines is inadequate to provide long-term critical care to patients with COVID-19. Added safety risks must be considered if no other option is available to treat severely ill patients during the ongoing pandemic.
Clinical trial number: Not applicable.
Keywords: ARDS; Anesthesia machine; COVID-19; Intensive care unit; Mechanical ventilation.
. 2021 May 20;21(1):155.
doi: 10.1186/s12871-021-01376-9.
The repurposed use of anesthesia machines to ventilate critically ill patients with coronavirus disease 2019 (COVID-19)
Maurizio Bottiroli[SUP] 1 [/SUP], Angelo Calini[SUP] 2 [/SUP], Riccardo Pinciroli[SUP] 3 [/SUP], Ariel Mueller[SUP] 3 [/SUP], Antonio Siragusa[SUP] 2 4 [/SUP], Carlo Anelli[SUP] 2 [/SUP], Richard D Urman[SUP] 5 [/SUP], Ala Nozari[SUP] 6 [/SUP], Lorenzo Berra[SUP] 3 [/SUP], Michele Mondino[SUP] 2 [/SUP], Roberto Fumagalli[SUP] 2 4 [/SUP]
Affiliations
- PMID: 34016056
- DOI: 10.1186/s12871-021-01376-9
Abstract
Background: The surge of critically ill patients due to the coronavirus disease-2019 (COVID-19) overwhelmed critical care capacity in areas of northern Italy. Anesthesia machines have been used as alternatives to traditional ICU mechanical ventilators. However, the outcomes for patients with COVID-19 respiratory failure cared for with Anesthesia Machines is currently unknow. We hypothesized that COVID-19 patients receiving care with Anesthesia Machines would have worse outcomes compared to standard practice.
Methods: We designed a retrospective study of patients admitted with a confirmed COVID-19 diagnosis at a large tertiary urban hospital in northern Italy. Two care units were included: a 27-bed standard ICU and a 15-bed temporary unit emergently opened in an operating room setting. Intubated patients assigned to Anesthesia Machines (AM group) were compared to a control cohort treated with standard mechanical ventilators (ICU-VENT group). Outcomes were assessed at 60-day follow-up. A multivariable Cox regression analysis of risk factors between survivors and non-survivors was conducted to determine the adjusted risk of death for patients assigned to AM group.
Results: Complete daily data from 89 mechanically ventilated patients consecutively admitted to the two units were analyzed. Seventeen patients were included in the AM group, whereas 72 were in the ICU-VENT group. Disease severity and intensity of treatment were comparable between the two groups. The 60-day mortality was significantly higher in the AM group compared to the ICU-vent group (12/17 vs. 27/72, 70.6% vs. 37.5%, respectively, p = 0.016). Allocation to AM group was associated with a significantly increased risk of death after adjusting for covariates (HR 4.05, 95% CI: 1.75-9.33, p = 0.001). Several incidents and complications were reported with Anesthesia Machine care, raising safety concerns.
Conclusions: Our results support the hypothesis that care associated with the use of Anesthesia Machines is inadequate to provide long-term critical care to patients with COVID-19. Added safety risks must be considered if no other option is available to treat severely ill patients during the ongoing pandemic.
Clinical trial number: Not applicable.
Keywords: ARDS; Anesthesia machine; COVID-19; Intensive care unit; Mechanical ventilation.