Non-invasive ventilation versus mechanical ventilation in hypoxemic patients with COVID-19
Autor: | Girish N. Nadkarni, Ron Do, Iain S. Forrest, Suraj K. Jaladanki, Benjamin S. Glicksberg, Ishan Paranjpe |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
0301 basic medicine
Microbiology (medical) medicine.medical_specialty medicine.medical_treatment 030106 microbiology Disease law.invention Cohort Studies 03 medical and health sciences 0302 clinical medicine Mechanical ventilation Randomized controlled trial law Internal medicine Critical care outcomes medicine Humans 030212 general & internal medicine Respiratory system Critical Care Outcomes Oxygen saturation (medicine) Retrospective Studies Original Paper Noninvasive Ventilation business.industry SARS-CoV-2 COVID-19 General Medicine Respiration Artificial Infectious Diseases Breathing Non-invasive ventilation business Cohort study |
Zdroj: | Infection |
ISSN: | 1439-0973 0300-8126 |
Popis: | Purpose Limited mechanical ventilators (MV) during the Coronavirus disease (COVID-19) pandemic have led to the use of non-invasive ventilation (NIV) in hypoxemic patients, which has not been studied well. We aimed to assess the association of NIV versus MV with mortality and morbidity during respiratory intervention among hypoxemic patients admitted with COVID-19. Methods We performed a retrospective multi-center cohort study across 5 hospitals during March–April 2020. Outcomes included mortality, severe COVID-19-related symptoms, time to discharge, and final oxygen saturation (SpO2) at the conclusion of the respiratory intervention. Multivariable regression of outcomes was conducted in all hypoxemic participants, 4 subgroups, and propensity-matched analysis. Results Of 2381 participants with laboratory-confirmed SARS-CoV-2, 688 were included in the study who were hypoxemic upon initiation of respiratory intervention. During the study period, 299 participants died (43%), 163 were admitted to the ICU (24%), and 121 experienced severe COVID-19-related symptoms (18%). Participants on MV had increased mortality than those on NIV (128/154 [83%] versus 171/534 [32%], OR = 30, 95% CI 16–60) with a mean survival of 6 versus 15 days, respectively. The MV group experienced more severe COVID-19-related symptoms [55/154 (36%) versus 66/534 (12%), OR = 4.3, 95% CI 2.7–6.8], longer time to discharge (mean 17 versus 7.1 days), and lower final SpO2 (92 versus 94%). Across all subgroups and propensity-matched analysis, MV was associated with a greater OR of death than NIV. Conclusions NIV was associated with lower respiratory intervention mortality and morbidity than MV. However, findings may be liable to unmeasured confounding and further study from randomized controlled trials is needed to definitively determine the role of NIV in hypoxemic patients with COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01633-6. |
Databáze: | OpenAIRE |
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