High Failure Rate of Noninvasive Oxygenation Strategies in Critically Ill Subjects With Acute Hypoxemic Respiratory Failure Due to COVID-19.
BACKGROUND: The efficacy of noninvasive oxygenation strategies (NIOS) in treating COVID-19 disease is unknown. We conducted a prospective observational study to assess the rate of NIOS failure in subjects treated in the ICU for hypoxemic respiratory failure due to COVID-19. METHODS: Patients receivi...
| Publicado en: | Respiratory Care Vol. 66; no. 5; pp. 705 - 715 |
|---|---|
| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
May2021
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=150127051&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 150127051 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: May2021 vid: 66 iid: 5 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 150127051 150127051 150127051 10.4187/respcare.08622 150127051 ppf: 705 ppct: 10 formats: fmt: @attributes: type: P tig: atl: High Failure Rate of Noninvasive Oxygenation Strategies in Critically Ill Subjects With Acute Hypoxemic Respiratory Failure Due to COVID-19. aug: au: Menga, Luca Salvatore Delle Cese, Luca Bongiovanni, Filippo Lombardi, Gianmarco Michi, Teresa Luciani, Filippo Cicetti, Marta Timpano, Jacopo Ferrante, Maria Cristina Cesarano, Melania Anzellotti, Gian Marco Rosà, Tommaso Natalini, Daniele Tanzarella, Eloisa S. Cutuli, Salvatore Lucio Pintaudi, Gabriele De Pascale, Gennaro Dell'Anna, Antonio M. Bello, Giuseppe Pennisi, Mariano Alberto affil: Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy sug: subj: COVID-19 Complications Respiratory Failure Therapy Anoxemia Therapy Positive Pressure Ventilation Methods Noninvasive Procedures Methods Intubation, Intratracheal Utilization Treatment Failure Risk Assessment Treatment Outcomes Evaluation Human Prospective Studies Nonexperimental Studies Critically Ill Patients Academic Medical Centers Intensive Care Units Inpatients Italy Clinical Assessment Tools Comparative Studies Matched Case Control Descriptive Statistics Lactate Dehydrogenase Blood Confidence Intervals Respiratory Failure Etiology Anoxemia Etiology Chi Square Test Fisher's Exact Test Kruskal-Wallis Test Wilcoxon Rank Sum Test T-Tests Survival Analysis Kaplan-Meier Estimator Multivariate Analysis Data Analysis Software Male Female Middle Age Aged Cox Proportional Hazards Model Middle Aged: 45-64 years Aged: 65+ years Male Female ab: BACKGROUND: The efficacy of noninvasive oxygenation strategies (NIOS) in treating COVID-19 disease is unknown. We conducted a prospective observational study to assess the rate of NIOS failure in subjects treated in the ICU for hypoxemic respiratory failure due to COVID-19. METHODS: Patients receiving first-line treatment NIOS for hypoxemic respiratory failure due to COVID-19 in the ICU of a university hospital were included in this study; laboratory data were collected upon arrival, and 28-d outcome was recorded. After propensity score matching based on Simplified Acute Physiology (SAPS) II score, age, PaO2/FIO2 and PaCO2 at arrival, the NIOS failure rate in subjects with COVID-19 was compared to a previously published cohort who received NIOS during hypoxemic respiratory failure due to other causes. RESULTS: A total of 85 subjects received first-line treatment with NIOS. The most frequently used methods were helmet noninvasive ventilation and high-flow nasal cannula; of these, 52 subjects (61%) required endotracheal intubation. Independent factors associated with NIOS failure were SAPS II score (P = .009) and serum lactate dehydrogenase at enrollment (P = .02); the combination of SAPS II score ≥ 33 with serum lactate dehydrogenase ≥ 405 units/L at ICU admission had 91% specificity in predicting the need for endotracheal intubation. In the propensity-matched cohorts (54 pairs), subjects with COVID-19 showed higher risk of NIOS failure than those with other causes of hypoxemic respiratory failure (59% vs 35%, P = .02), with an adjusted hazard ratio of 2 (95% CI 1.1-3.6, P = .01). CONCLUSIONS: As compared to hypoxemic respiratory failure due to other etiologies, subjects with COVID-19 who were treated with NIOS in the ICU were burdened by a 2-fold higher risk of failure. Subjects with a SAPS II score 6 33 and serum lactate dehydrogenase ≥ 405 units/L represent the population with the greatest risk. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|