Improved COVID-19 outcomes in a large non-invasive respiratory support cohort despite emergence of the alpha variant
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ..
INTRODUCTION: Respiratory high-dependency units (rHDUs) are used to manage respiratory failure in COVID-19 outside of the intensive care unit (ICU). The alpha variant of COVID-19 has been linked to increased rates of mortality and admission to ICU; however, its impact on a rHDU population is not known. We aimed to compare rHDU outcomes between the two main UK waves of COVID-19 infection and evaluate the impact of the alpha variant on second wave outcomes.
METHODS: We conducted a single-centre, retrospective analysis of all patients with a diagnosis of COVID-19 admitted to the rHDU of our teaching hospital for respiratory support during the first and second main UK waves.
RESULTS: In total, 348 patients were admitted to rHDU. In the second wave, mortality (26.7% s vs 50.7% first wave, χ2=14.7, df=1, p=0.0001) and intubation rates in those eligible (24.3% s vs 58.8% first wave, χ2=17.3, df=2, p=0.0002) were improved compared with the first wave. In the second wave, the alpha variant had no effect on mortality (OR 1.18, 95% CI 0.60 to 2.32, p=0.64). Continuous positive airway pressure (CPAP) (89.5%) and awake proning (85.6%) were used in most patients in the second wave.
DISCUSSION: Our single-centre experience shows that rHDU mortality and intubation rates have improved over time in spite of the emergence of the alpha variant. Our data support the use of CPAP and awake proning, although improvements in outcome are likely to be multifactorial.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2021 |
|---|---|
| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:8 |
|---|---|
| Enthalten in: |
BMJ open respiratory research - 8(2021), 1 vom: 30. Nov. |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Turnbull, Chris D [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
COVID-19 |
|---|
| Anmerkungen: |
Date Completed 06.12.2021 Date Revised 04.01.2022 published: Print Citation Status MEDLINE |
|---|
| doi: |
10.1136/bmjresp-2021-001044 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM333854802 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM333854802 | ||
| 003 | DE-627 | ||
| 005 | 20231225222512.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2021 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1136/bmjresp-2021-001044 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1112.xml |
| 035 | |a (DE-627)NLM333854802 | ||
| 035 | |a (NLM)34848495 | ||
| 035 | |a (PII)e001044 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Turnbull, Chris D |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Improved COVID-19 outcomes in a large non-invasive respiratory support cohort despite emergence of the alpha variant |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 06.12.2021 | ||
| 500 | |a Date Revised 04.01.2022 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a INTRODUCTION: Respiratory high-dependency units (rHDUs) are used to manage respiratory failure in COVID-19 outside of the intensive care unit (ICU). The alpha variant of COVID-19 has been linked to increased rates of mortality and admission to ICU; however, its impact on a rHDU population is not known. We aimed to compare rHDU outcomes between the two main UK waves of COVID-19 infection and evaluate the impact of the alpha variant on second wave outcomes | ||
| 520 | |a METHODS: We conducted a single-centre, retrospective analysis of all patients with a diagnosis of COVID-19 admitted to the rHDU of our teaching hospital for respiratory support during the first and second main UK waves | ||
| 520 | |a RESULTS: In total, 348 patients were admitted to rHDU. In the second wave, mortality (26.7% s vs 50.7% first wave, χ2=14.7, df=1, p=0.0001) and intubation rates in those eligible (24.3% s vs 58.8% first wave, χ2=17.3, df=2, p=0.0002) were improved compared with the first wave. In the second wave, the alpha variant had no effect on mortality (OR 1.18, 95% CI 0.60 to 2.32, p=0.64). Continuous positive airway pressure (CPAP) (89.5%) and awake proning (85.6%) were used in most patients in the second wave | ||
| 520 | |a DISCUSSION: Our single-centre experience shows that rHDU mortality and intubation rates have improved over time in spite of the emergence of the alpha variant. Our data support the use of CPAP and awake proning, although improvements in outcome are likely to be multifactorial | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a non invasive ventilation | |
| 700 | 1 | |a Porter, Benedict M L |e verfasserin |4 aut | |
| 700 | 1 | |a Evans, Sarah B |e verfasserin |4 aut | |
| 700 | 1 | |a Smith, Oliver |e verfasserin |4 aut | |
| 700 | 1 | |a Lardner, Rachel |e verfasserin |4 aut | |
| 700 | 1 | |a Hallifax, Robert |e verfasserin |4 aut | |
| 700 | 1 | |a Bettinson, Henry V |e verfasserin |4 aut | |
| 700 | 1 | |a Talbot, Nicholas P |e verfasserin |4 aut | |
| 700 | 1 | |a Bafadhel, Mona |e verfasserin |4 aut | |
| 700 | 1 | |a Rahman, Najib M |e verfasserin |4 aut | |
| 700 | 1 | |a Petousi, Nayia |e verfasserin |4 aut | |
| 700 | 0 | |a Oxford Respiratory Group |e verfasserin |4 aut | |
| 700 | 1 | |a Achaiah, Andrew |e investigator |4 oth | |
| 700 | 1 | |a Addala, Dinesh |e investigator |4 oth | |
| 700 | 1 | |a Banka, Radhika |e investigator |4 oth | |
| 700 | 1 | |a Bedawi, Eihab |e investigator |4 oth | |
| 700 | 1 | |a Chapman, Stephen |e investigator |4 oth | |
| 700 | 1 | |a Danbury, Hannah |e investigator |4 oth | |
| 700 | 1 | |a Couillard, Simon |e investigator |4 oth | |
| 700 | 1 | |a Douglas, Eric |e investigator |4 oth | |
| 700 | 1 | |a Elder, Patrick |e investigator |4 oth | |
| 700 | 1 | |a Fries, Anastasia |e investigator |4 oth | |
| 700 | 1 | |a Flight, William |e investigator |4 oth | |
| 700 | 1 | |a Fraser, Emily |e investigator |4 oth | |
| 700 | 1 | |a Hardinge, Maxine |e investigator |4 oth | |
| 700 | 1 | |a Hinks, Timothy |e investigator |4 oth | |
| 700 | 1 | |a Ho, Ling Pei |e investigator |4 oth | |
| 700 | 1 | |a Hoyles, Rachel |e investigator |4 oth | |
| 700 | 1 | |a Melhorn, James |e investigator |4 oth | |
| 700 | 1 | |a Moore, Alastair |e investigator |4 oth | |
| 700 | 1 | |a Nathwani, Vishal |e investigator |4 oth | |
| 700 | 1 | |a Nickol, Annabel |e investigator |4 oth | |
| 700 | 1 | |a Park, John |e investigator |4 oth | |
| 700 | 1 | |a Patel, Shefaly |e investigator |4 oth | |
| 700 | 1 | |a Pavord, Ian |e investigator |4 oth | |
| 700 | 1 | |a Saunders, Peter |e investigator |4 oth | |
| 700 | 1 | |a Laurenson-Schafer, Hannah |e investigator |4 oth | |
| 700 | 1 | |a Roxburgh, Francesca |e investigator |4 oth | |
| 700 | 1 | |a Sundaralingam, Anand |e investigator |4 oth | |
| 700 | 1 | |a Sykes, Anny |e investigator |4 oth | |
| 700 | 1 | |a Tsakok, Maria |e investigator |4 oth | |
| 700 | 1 | |a Wilson, Robert |e investigator |4 oth | |
| 700 | 1 | |a Wrightson, John M |e investigator |4 oth | |
| 773 | 0 | 8 | |i Enthalten in |t BMJ open respiratory research |d 2013 |g 8(2021), 1 vom: 30. Nov. |w (DE-627)NLM244313849 |x 2052-4439 |7 nnns |
| 773 | 1 | 8 | |g volume:8 |g year:2021 |g number:1 |g day:30 |g month:11 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1136/bmjresp-2021-001044 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 8 |j 2021 |e 1 |b 30 |c 11 | ||