Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

BACKGROUND: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk fact...

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Autores principales: Reyes, Luis Felipe, Murthy, Srinivas, Garcia-Gallo, Esteban, Merson, Laura, Ibáñez-Prada, Elsa D., Rello, Jordi, Fuentes, Yuli V., Martin-Loeches, Ignacio, Bozza, Fernando, Duque, Sara, Taccone, Fabio S., Fowler, Robert A., Kartsonaki, Christiana, Gonçalves, Bronner P., Citarella, Barbara Wanjiru, Aryal, Diptesh, Burhan, Erlina, Cummings, Matthew J., Delmas, Christelle, Diaz, Rodrigo, Figueiredo-Mello, Claudia, Hashmi, Madiha, Panda, Prasan Kumar, Jiménez, Miguel Pedrera, Rincon, Diego Fernando Bautista, Thomson, David, Nichol, Alistair, Marshall, John C., Olliaro, Piero L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9469080/
https://www.ncbi.nlm.nih.gov/pubmed/36100904
http://dx.doi.org/10.1186/s13054-022-04155-1
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author Reyes, Luis Felipe
Murthy, Srinivas
Garcia-Gallo, Esteban
Merson, Laura
Ibáñez-Prada, Elsa D.
Rello, Jordi
Fuentes, Yuli V.
Martin-Loeches, Ignacio
Bozza, Fernando
Duque, Sara
Taccone, Fabio S.
Fowler, Robert A.
Kartsonaki, Christiana
Gonçalves, Bronner P.
Citarella, Barbara Wanjiru
Aryal, Diptesh
Burhan, Erlina
Cummings, Matthew J.
Delmas, Christelle
Diaz, Rodrigo
Figueiredo-Mello, Claudia
Hashmi, Madiha
Panda, Prasan Kumar
Jiménez, Miguel Pedrera
Rincon, Diego Fernando Bautista
Thomson, David
Nichol, Alistair
Marshall, John C.
Olliaro, Piero L.
author_facet Reyes, Luis Felipe
Murthy, Srinivas
Garcia-Gallo, Esteban
Merson, Laura
Ibáñez-Prada, Elsa D.
Rello, Jordi
Fuentes, Yuli V.
Martin-Loeches, Ignacio
Bozza, Fernando
Duque, Sara
Taccone, Fabio S.
Fowler, Robert A.
Kartsonaki, Christiana
Gonçalves, Bronner P.
Citarella, Barbara Wanjiru
Aryal, Diptesh
Burhan, Erlina
Cummings, Matthew J.
Delmas, Christelle
Diaz, Rodrigo
Figueiredo-Mello, Claudia
Hashmi, Madiha
Panda, Prasan Kumar
Jiménez, Miguel Pedrera
Rincon, Diego Fernando Bautista
Thomson, David
Nichol, Alistair
Marshall, John C.
Olliaro, Piero L.
author_sort Reyes, Luis Felipe
collection PubMed
description BACKGROUND: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). METHODS: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. RESULTS: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). CONCLUSIONS: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-022-04155-1.
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spelling pubmed-94690802022-09-13 Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study Reyes, Luis Felipe Murthy, Srinivas Garcia-Gallo, Esteban Merson, Laura Ibáñez-Prada, Elsa D. Rello, Jordi Fuentes, Yuli V. Martin-Loeches, Ignacio Bozza, Fernando Duque, Sara Taccone, Fabio S. Fowler, Robert A. Kartsonaki, Christiana Gonçalves, Bronner P. Citarella, Barbara Wanjiru Aryal, Diptesh Burhan, Erlina Cummings, Matthew J. Delmas, Christelle Diaz, Rodrigo Figueiredo-Mello, Claudia Hashmi, Madiha Panda, Prasan Kumar Jiménez, Miguel Pedrera Rincon, Diego Fernando Bautista Thomson, David Nichol, Alistair Marshall, John C. Olliaro, Piero L. Crit Care Research BACKGROUND: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). METHODS: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. RESULTS: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). CONCLUSIONS: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-022-04155-1. BioMed Central 2022-09-13 /pmc/articles/PMC9469080/ /pubmed/36100904 http://dx.doi.org/10.1186/s13054-022-04155-1 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Reyes, Luis Felipe
Murthy, Srinivas
Garcia-Gallo, Esteban
Merson, Laura
Ibáñez-Prada, Elsa D.
Rello, Jordi
Fuentes, Yuli V.
Martin-Loeches, Ignacio
Bozza, Fernando
Duque, Sara
Taccone, Fabio S.
Fowler, Robert A.
Kartsonaki, Christiana
Gonçalves, Bronner P.
Citarella, Barbara Wanjiru
Aryal, Diptesh
Burhan, Erlina
Cummings, Matthew J.
Delmas, Christelle
Diaz, Rodrigo
Figueiredo-Mello, Claudia
Hashmi, Madiha
Panda, Prasan Kumar
Jiménez, Miguel Pedrera
Rincon, Diego Fernando Bautista
Thomson, David
Nichol, Alistair
Marshall, John C.
Olliaro, Piero L.
Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study
title Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study
title_full Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study
title_fullStr Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study
title_full_unstemmed Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study
title_short Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study
title_sort respiratory support in patients with severe covid-19 in the international severe acute respiratory and emerging infection (isaric) covid-19 study: a prospective, multinational, observational study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9469080/
https://www.ncbi.nlm.nih.gov/pubmed/36100904
http://dx.doi.org/10.1186/s13054-022-04155-1
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