tetano
Editor, Senior Moderator
J Clin Med
. 2022 Oct 14;11(20):6063.
doi: 10.3390/jcm11206063.
Outcomes of COVID-19 Patients with Severe Hypoxemic Acute Respiratory Failure: Non-Invasive Ventilation vs. Straight Intubation-A Propensity Score-Matched Multicenter Cohort Study
Laura Pasin[SUP] 1 [/SUP], Dario Gregori[SUP] 2 [/SUP], Tommaso Pettenuzzo[SUP] 1 [/SUP], Alessandro De Cassai[SUP] 1 [/SUP], Annalisa Boscolo[SUP] 1 [/SUP], Nicolò Sella[SUP] 3 [/SUP], Giulia Lorenzoni[SUP] 2 [/SUP], Federico Geraldini[SUP] 1 [/SUP], Elisa Pistollato[SUP] 3 [/SUP], Vito Marco Ranieri[SUP] 4 [/SUP], Giovanni Landoni[SUP] 5 [/SUP], Paolo Rosi[SUP] 6 [/SUP], Paolo Navalesi[SUP] 1 3 [/SUP], Covid-Veneto Icu Network
Affiliations
Abstract
The best timing for endotracheal intubation in patients with coronavirus disease 2019 (COVID-19) hypoxemic acute respiratory failure (hARF) remains debated. Aim of this study is to compare the outcomes of COVID-19 patients with hARF receiving either a trial of non-invasive ventilation (NIV) or intubated with no prior attempt of NIV ("straight intubation"). All consecutive patients admitted to the 25 participating ICUs were included and divided in two groups: the "straight intubation" group and the "NIV" group. A propensity score matching was performed to correct for biases associated with the choice of the respiratory support. Primary outcome was in-hospital mortality. Secondary outcomes were length of mechanical ventilation, hospital stay and reintubation rate. A total of 704 COVID-19 patients were admitted to ICUs during the study period. After matching, 141 patients were included in each group. No clinically relevant difference at ICU admission was found between groups. In-hospital mortality was significantly lower in the NIV group (22.0% vs. 36.2%), with no significant difference in secondary endpoints. There was no significant mortality difference between patients who received straight intubation and those intubated after NIV failure. In COVID-19 patients with hARF it is worth and safe attempting a trial of NIV prior to intubation.
Keywords: SARS-CoV-2; mechanical ventilation; mortality; non-invasive ventilation.
. 2022 Oct 14;11(20):6063.
doi: 10.3390/jcm11206063.
Outcomes of COVID-19 Patients with Severe Hypoxemic Acute Respiratory Failure: Non-Invasive Ventilation vs. Straight Intubation-A Propensity Score-Matched Multicenter Cohort Study
Laura Pasin[SUP] 1 [/SUP], Dario Gregori[SUP] 2 [/SUP], Tommaso Pettenuzzo[SUP] 1 [/SUP], Alessandro De Cassai[SUP] 1 [/SUP], Annalisa Boscolo[SUP] 1 [/SUP], Nicolò Sella[SUP] 3 [/SUP], Giulia Lorenzoni[SUP] 2 [/SUP], Federico Geraldini[SUP] 1 [/SUP], Elisa Pistollato[SUP] 3 [/SUP], Vito Marco Ranieri[SUP] 4 [/SUP], Giovanni Landoni[SUP] 5 [/SUP], Paolo Rosi[SUP] 6 [/SUP], Paolo Navalesi[SUP] 1 3 [/SUP], Covid-Veneto Icu Network
Affiliations
- PMID: 36294387
- DOI: 10.3390/jcm11206063
Abstract
The best timing for endotracheal intubation in patients with coronavirus disease 2019 (COVID-19) hypoxemic acute respiratory failure (hARF) remains debated. Aim of this study is to compare the outcomes of COVID-19 patients with hARF receiving either a trial of non-invasive ventilation (NIV) or intubated with no prior attempt of NIV ("straight intubation"). All consecutive patients admitted to the 25 participating ICUs were included and divided in two groups: the "straight intubation" group and the "NIV" group. A propensity score matching was performed to correct for biases associated with the choice of the respiratory support. Primary outcome was in-hospital mortality. Secondary outcomes were length of mechanical ventilation, hospital stay and reintubation rate. A total of 704 COVID-19 patients were admitted to ICUs during the study period. After matching, 141 patients were included in each group. No clinically relevant difference at ICU admission was found between groups. In-hospital mortality was significantly lower in the NIV group (22.0% vs. 36.2%), with no significant difference in secondary endpoints. There was no significant mortality difference between patients who received straight intubation and those intubated after NIV failure. In COVID-19 patients with hARF it is worth and safe attempting a trial of NIV prior to intubation.
Keywords: SARS-CoV-2; mechanical ventilation; mortality; non-invasive ventilation.