Risk factors for non-invasive/invasive ventilatory support in patients with COVID-19 pneumonia: A retrospective study within a multidisciplinary approach

Autor: Raffaella Papa, Vittorio Pavoni, Caterina Stera, Tommaso Meconi, Maddalena Pazzi, Lorenzo Roberto Suardi, Pierluigi Blanc, Sara Esperti, Carlo Pallotto, Francesca Covani Frigieri, Filippo Baragli, Martina Carlucci, Elisa Tazzioli, Annarita Botta, Elena Salomoni
Rok vydání: 2020
Předmět:
Male
0301 basic medicine
medicine.medical_treatment
medicine.disease_cause
law.invention
Cohort Studies
0302 clinical medicine
law
Oxygen therapy
Positive airway pressure
risk factors
Venturi mask
Hospital Mortality
030212 general & internal medicine
Continuous positive airway pressure
Aged
80 and over
non-invasive ventilation
General Medicine
Middle Aged
Intensive care unit
Hospitalization
Intensive Care Units
Infectious Diseases
Italy
Anesthesia
Female
SOFA score
Nasal cannula
Adult
Microbiology (medical)
Critical Illness
030106 microbiology
Article
lcsh:Infectious and parasitic diseases
03 medical and health sciences
invasive ventilation
medicine
Humans
lcsh:RC109-216
Pandemics
Aged
Retrospective Studies
Mechanical ventilation
SARS-CoV-2
business.industry
COVID-19
Respiration
Artificial
Diabetes Mellitus
Type 2
business
multidisciplinary
Zdroj: International Journal of Infectious Diseases
International Journal of Infectious Diseases, Vol 100, Iss, Pp 258-263 (2020)
ISSN: 1201-9712
Popis: Highlights • SARS-CoV-2 cause a wide spectrum of clinical manifestations including acute respiratory distress syndrome (ARDS) manifestation. • Continuous positive airway pressure, or non-invasive ventilation, and invasive ventilatory support are often required to manage the acute respiratory failure in COVID-19 patients. • Temperature >38 °C, LDH > 250 U/L and d-dimer >1000 ng/ml resulted to be indipendent risk factors for non invasive/invasive ventilator support requirement. • An early inflammatory screening should be warranted in order to stratify the illness severity and provide an appropriate treatment.
Objectives To investigate risk factors for non-invasive/invasive-ventilatory support (NI/I-VS) in Coronavirus diseases 2019 (COVID-19) patients. Methods All consecutive patients admitted, from February 25 to April 25, 2020, to the Infectious Diseases Unit and Intensive Care Unit of Santa Maria Annunziata Hospital (Florence, Italy) with confirmed COVID-19 diagnosis were enrolled in this retrospective cohort study. NI/I-VS was defined as need for continuous positive airway pressure (CPAP) or bilevel positive pressure non-invasive ventilation (BPAP) or mechanical ventilation (MV) than low-flow systems oxygen-therapy as Venturi Mask (VM) or nasal cannula. Results Ninety-seven patients were enrolled; 61,9% (60/97) were male, median age was 64 years; intra-hospital mortality was 9.3%. Thirty five out of 97 (36%) patients required ICU admission and 94.8% (92/97) were prescribed oxygen-therapy: 10.8% (10/92) with nasal cannula, 44.5% (41/92) with VM, 31.5% (29/92) with CPAP, 2.2% (2/92) with BPAP and 10.8% (10/92) underwent intubation for MV. Patients with body mass index >30, type II diabetes mellitus and presenting at the admission with dyspnoea, asthenia, SOFA score ≥2 points, PaO2/FiO2 38 °C, increased levels of lactate dehydrogenase (LDH), alanine aminotransferase, C-reactive protein and a d-dimer >1000 ng/ml underwent more frequently NI/I-VS at the univariate analysis. Multivariate logistic regression analysis confirmed temperature >38 °C (odds ratio [OR] 21.2, 95% confidential interval [95%CI] 3.5-124.5, p = 0.001), LDH > 250 U/L (OR 15.2, 95%CI 1.8-128.8, p = 0.012) and d-dimer >1000 ng/ml (OR 4.5, 95%CI 1.2-17.3, p = 0.027) as significantly associated with NI/I-VS requirement. A non-significant trend (p = 0.051) was described for PaO2/FiO2 38 °C, LDH > 250 U/L and d-dimer >1000 ng/ml resulted to be indipendent risk factors for NI/I-VS in COVID-19 patients. In order to quickly recognize patients likely at risk to develop a critical illness, inflammatory markers assessment should be warranted upon hospital admission.
Databáze: OpenAIRE
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