Protective ventilation and outcomes of critically ill patients with COVID-19 : a cohort study
BACKGROUND: Approximately 5% of COVID-19 patients develop respiratory failure and need ventilatory support, yet little is known about the impact of mechanical ventilation strategy in COVID-19. Our objective was to describe baseline characteristics, ventilatory parameters, and outcomes of critically ill patients in the largest referral center for COVID-19 in Sao Paulo, Brazil, during the first surge of the pandemic.
METHODS: This cohort included COVID-19 patients admitted to the intensive care units (ICUs) of an academic hospital with 94 ICU beds, a number expanded to 300 during the pandemic as part of a state preparedness plan. Data included demographics, advanced life support therapies, and ventilator parameters. The main outcome was 28-day survival. We used a multivariate Cox model to test the association between protective ventilation and survival, adjusting for PF ratio, pH, compliance, and PEEP.
RESULTS: We included 1503 patients from March 30 to June 30, 2020. The mean age was 60 ± 15 years, and 59% were male. During 28-day follow-up, 1180 (79%) patients needed invasive ventilation and 666 (44%) died. For the 984 patients who were receiving mechanical ventilation in the first 24 h of ICU stay, mean tidal volume was 6.5 ± 1.3 mL/kg of ideal body weight, plateau pressure was 24 ± 5 cmH2O, respiratory system compliance was 31.9 (24.4-40.9) mL/cmH2O, and 82% of patients were ventilated with protective ventilation. Noninvasive ventilation was used in 21% of patients, and prone, in 36%. Compliance was associated with survival and did not show a bimodal pattern that would support the presence of two phenotypes. In the multivariable model, protective ventilation (aHR 0.73 [95%CI 0.57-0.94]), adjusted for PF ratio, compliance, PEEP, and arterial pH, was independently associated with survival.
CONCLUSIONS: During the peak of the epidemic in Sao Paulo, critically ill patients with COVID-19 often required mechanical ventilation and mortality was high. Our findings revealed an association between mechanical ventilation strategy and mortality, highlighting the importance of protective ventilation for patients with COVID-19.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:11 |
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| Enthalten in: |
Annals of intensive care - 11(2021), 1 vom: 07. Juni, Seite 92 |
| Sprache: |
Englisch |
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| Links: |
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| Themen: |
COVID-19 |
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| Anmerkungen: |
Date Revised 10.06.2021 published: Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1186/s13613-021-00882-w |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM326453431 |
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| 100 | 1 | |a Ferreira, Juliana C |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Protective ventilation and outcomes of critically ill patients with COVID-19 |b a cohort study |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Revised 10.06.2021 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a BACKGROUND: Approximately 5% of COVID-19 patients develop respiratory failure and need ventilatory support, yet little is known about the impact of mechanical ventilation strategy in COVID-19. Our objective was to describe baseline characteristics, ventilatory parameters, and outcomes of critically ill patients in the largest referral center for COVID-19 in Sao Paulo, Brazil, during the first surge of the pandemic | ||
| 520 | |a METHODS: This cohort included COVID-19 patients admitted to the intensive care units (ICUs) of an academic hospital with 94 ICU beds, a number expanded to 300 during the pandemic as part of a state preparedness plan. Data included demographics, advanced life support therapies, and ventilator parameters. The main outcome was 28-day survival. We used a multivariate Cox model to test the association between protective ventilation and survival, adjusting for PF ratio, pH, compliance, and PEEP | ||
| 520 | |a RESULTS: We included 1503 patients from March 30 to June 30, 2020. The mean age was 60 ± 15 years, and 59% were male. During 28-day follow-up, 1180 (79%) patients needed invasive ventilation and 666 (44%) died. For the 984 patients who were receiving mechanical ventilation in the first 24 h of ICU stay, mean tidal volume was 6.5 ± 1.3 mL/kg of ideal body weight, plateau pressure was 24 ± 5 cmH2O, respiratory system compliance was 31.9 (24.4-40.9) mL/cmH2O, and 82% of patients were ventilated with protective ventilation. Noninvasive ventilation was used in 21% of patients, and prone, in 36%. Compliance was associated with survival and did not show a bimodal pattern that would support the presence of two phenotypes. In the multivariable model, protective ventilation (aHR 0.73 [95%CI 0.57-0.94]), adjusted for PF ratio, compliance, PEEP, and arterial pH, was independently associated with survival | ||
| 520 | |a CONCLUSIONS: During the peak of the epidemic in Sao Paulo, critically ill patients with COVID-19 often required mechanical ventilation and mortality was high. Our findings revealed an association between mechanical ventilation strategy and mortality, highlighting the importance of protective ventilation for patients with COVID-19 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Pneumonia, viral | |
| 650 | 4 | |a SARS virus | |
| 650 | 4 | |a Severe acute respiratory syndrome | |
| 650 | 4 | |a Ventilation, artificial | |
| 700 | 1 | |a Ho, Yeh-Li |e verfasserin |4 aut | |
| 700 | 1 | |a Besen, Bruno Adler Maccagnan Pinheiro |e verfasserin |4 aut | |
| 700 | 1 | |a Malbouisson, Luiz Marcelo Sa |e verfasserin |4 aut | |
| 700 | 1 | |a Taniguchi, Leandro Utino |e verfasserin |4 aut | |
| 700 | 1 | |a Mendes, Pedro Vitale |e verfasserin |4 aut | |
| 700 | 1 | |a Costa, Eduardo Leite Vieira |e verfasserin |4 aut | |
| 700 | 1 | |a Park, Marcelo |e verfasserin |4 aut | |
| 700 | 1 | |a Daltro-Oliveira, Renato |e verfasserin |4 aut | |
| 700 | 1 | |a Roepke, Roberta M L |e verfasserin |4 aut | |
| 700 | 1 | |a Silva-Jr, Joao M |e verfasserin |4 aut | |
| 700 | 1 | |a Carmona, Maria Jose Carvalho |e verfasserin |4 aut | |
| 700 | 1 | |a Carvalho, Carlos R R |e verfasserin |4 aut | |
| 700 | 0 | |a EPICCoV Study Group |e verfasserin |4 aut | |
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| 700 | 1 | |a Kanasiro, Alberto Kendy |e investigator |4 oth | |
| 700 | 1 | |a Crescenzi, Alessandra |e investigator |4 oth | |
| 700 | 1 | |a Fernandes, Amanda Coelho |e investigator |4 oth | |
| 700 | 1 | |a Miethke-Morais, Anna |e investigator |4 oth | |
| 700 | 1 | |a Bellintani, Arthur Petrillo |e investigator |4 oth | |
| 700 | 1 | |a Canasiro, Artur Ribeiro |e investigator |4 oth | |
| 700 | 1 | |a Carneiro, Bárbara Vieira |e investigator |4 oth | |
| 700 | 1 | |a Zanbon, Beatriz Keiko |e investigator |4 oth | |
| 700 | 1 | |a Batista, Bernardo Pinheiro Senna Nogueira |e investigator |4 oth | |
| 700 | 1 | |a Nicolao, Bianca Ruiz |e investigator |4 oth | |
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| 700 | 1 | |a Biselli, Bruno |e investigator |4 oth | |
| 700 | 1 | |a De Macedo, Bruno Rocha |e investigator |4 oth | |
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| 700 | 1 | |a De Carvalho, Carlos Roberto Ribeiro |e investigator |4 oth | |
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| 700 | 1 | |a Stipanich, Cassio |e investigator |4 oth | |
| 700 | 1 | |a Bueno, Caue Gasparotto |e investigator |4 oth | |
| 700 | 1 | |a Garzillo, Cibele |e investigator |4 oth | |
| 700 | 1 | |a Tanaka, Clarice |e investigator |4 oth | |
| 700 | 1 | |a Forte, Daniel Neves |e investigator |4 oth | |
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| 700 | 1 | |a Robira, Daniele |e investigator |4 oth | |
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| 700 | 1 | |a Regalio, Fabiane Aliotti |e investigator |4 oth | |
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| 700 | 1 | |a Louro, Giulia Sefrin |e investigator |4 oth | |
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| 700 | 1 | |a Ferreira, Juliana Carvalho |e investigator |4 oth | |
| 700 | 1 | |a Galleti, Karine Vusberg |e investigator |4 oth | |
| 700 | 1 | |a Silva, Katia Regina |e investigator |4 oth | |
| 700 | 1 | |a Isensee, Larissa Padrao |e investigator |4 oth | |
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| 700 | 1 | |a Pedro, Rodolpho Augusto Moura |e investigator |4 oth | |
| 700 | 1 | |a Kondo, Rodrigo |e investigator |4 oth | |
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