Department of Cardiology, San Giovanni Bosco Hospital, Turin, Piemonte, Italy
Emergency Medicine Department, Martini Hospital Centre, Torino, Piemonte, Italy.
Emerg Med J. 2021 May;38(5):359-365. doi: 10.1136/emermed-2020-210411. Epub 2021 Mar 16.
The COVID-19 pandemic has seriously challenged worldwide healthcare systems and limited intensive care facilities, leading to physicians considering the use of non-invasive ventilation (NIV) for managing SARS-CoV-2-related acute respiratory failure (ARF).
We conducted an interim analysis of the international, multicentre HOPE COVID-19 registry including patients admitted for a confirmed or highly suspected SARS-CoV-2 infection until 18 April 2020. Those treated with NIV were considered. The primary endpoint was a composite of death or need for intubation. The components of the composite endpoint were the secondary outcomes. Unadjusted and adjusted predictors of the primary endpoint within those initially treated with NIV were investigated.
1933 patients who were included in the registry during the study period had data on oxygen support type. Among them, 390 patients (20%) were treated with NIV. Compared with those receiving other non-invasive oxygen strategy, patients receiving NIV showed significantly worse clinical and laboratory signs of ARF at presentation. Of the 390 patients treated with NIV, 173 patients (44.4%) met the composite endpoint. In-hospital death was the main determinant (147, 37.7%), while 62 patients (15.9%) needed invasive ventilation. Those requiring invasive ventilation had the lowest survival rate (41.9%). After adjustment, age (adjusted OR (adj(OR)) for 5-year increase: 1.37, 95% CI 1.15 to 1.63, p<0.001), hypertension (adj(OR) 2.95, 95% CI 1.14 to 7.61, p=0.03), room air O saturation <92% at presentation (adj(OR) 3.05, 95% CI 1.28 to 7.28, p=0.01), lymphocytopenia (adj(OR) 3.55, 95% CI 1.16 to 10.85, p=0.03) and in-hospital use of antibiotic therapy (adj(OR) 4.91, 95% CI 1.69 to 14.26, p=0.003) were independently associated with the composite endpoint.
NIV was used in a significant proportion of patients within our cohort, and more than half of these patients survived without the need for intubation. NIV may represent a viable strategy particularly in case of overcrowded and limited intensive care resources, but prompt identification of failure is mandatory to avoid harm. Further studies are required to better clarify our hypothesis.
NCT04334291/EUPAS34399.
COVID-19 大流行严重挑战了全球医疗体系，并限制了重症监护病房的容量，导致医生考虑使用无创通气（NIV）来治疗与 SARS-CoV-2 相关的急性呼吸衰竭（ARF）。
我们对国际多中心 HOPE COVID-19 注册研究进行了中期分析，该研究纳入了截至 2020 年 4 月 18 日因确诊或高度疑似 SARS-CoV-2 感染而入院的患者。我们对接受 NIV 治疗的患者进行了分析。主要终点为死亡或需要插管的复合终点。次要结局为复合终点的组成部分。我们在最初接受 NIV 治疗的患者中，对主要终点的未调整和调整后的预测因素进行了调查。
在研究期间，共有 1933 例患者纳入了该注册研究，其中有 390 例（20%）患者接受了 NIV 治疗。与接受其他无创氧疗策略的患者相比，接受 NIV 治疗的患者在入院时表现出更严重的 ARF 临床和实验室征象。在接受 NIV 治疗的 390 例患者中，有 173 例（44.4%）达到了复合终点。院内死亡是主要决定因素（147 例，37.7%），而 62 例（15.9%）需要有创通气。需要有创通气的患者生存率最低（41.9%）。调整后，年龄（每增加 5 岁的调整比值比（adj(OR)）：1.37，95%置信区间（CI）1.15 至 1.63，p<0.001）、高血压（adj(OR)2.95，95%CI1.14 至 7.61，p=0.03）、入院时空气 O 饱和度<92%（adj(OR)3.05，95%CI1.28 至 7.28，p=0.01）、淋巴细胞减少症（adj(OR)3.55，95%CI1.16 至 10.85，p=0.03）和院内使用抗生素治疗（adj(OR)4.91，95%CI1.69 至 14.26，p=0.003）与复合终点独立相关。
在我们的队列中，NIV 被用于很大一部分患者，其中超过一半的患者无需插管即可存活。NIV 可能是一种可行的策略，特别是在重症监护资源拥挤和有限的情况下，但必须及时识别失败，以避免造成伤害。需要进一步的研究来更好地阐明我们的假设。
NCT04334291/EUPAS34399。
