Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30 - 901, Kraków, Poland.
Department of Pulmonology, Jagiellonian University Medical College, Kraków, Poland.
Crit Care. 2022 Jul 22;26(1):224. doi: 10.1186/s13054-022-04082-1.
Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV.
This is a substudy of COVIP study-an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality.
Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36-5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06-2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI - 2.27 to - 0.46 days) compared to primary IMV group (n = 1876).
Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV. Clinical Trial Registration NCT04321265 , registered 19 March 2020, https://clinicaltrials.gov .
在 COVID-19 大流行期间，重症监护病房（ICU）床位短缺，无创通气（NIV）是一种有前途的替代有创机械通气（IMV）的方法。我们旨在评估 NIV 在欧洲的使用情况以及与接受 NIV 治疗的患者结局相关的因素。
这是一项国际前瞻性观察性研究 COVIP 研究的子研究，该研究纳入了年龄≥70 岁且确诊 COVID-19 的 ICU 患者。我们于 2020 年 3 月至 2021 年 4 月在 15 个欧洲国家的 156 个 ICU 中招募患者。主要终点是 30 天死亡率。
队列包括 3074 名患者，其中大多数为男性（2197/3074，71.4%），平均年龄为 75.7 岁（标准差 4.6）。NIV 的使用频率为 25.7%，在参与国家之间从 1.1%到 62.0%不等。主要 NIV 失败，定义为在 ICU 入院后 30 天内需要气管插管或死亡，发生在 629/470（74.7%）患者中。与 NIV 失败风险增加相关的因素包括更高的序贯器官衰竭评估（SOFA）评分（比值比 3.73，95%置信区间 2.36-5.90）和入院时的临床虚弱量表（CFS）（比值比 1.46，95%置信区间 1.06-2.00）。与最初接受 NIV 治疗的患者（n=630）相比，主要接受 IMV 治疗的患者（n=1876）存活天数少 1.36 天（95%置信区间-2.27 至-0.46 天）。
NIV 在欧洲国家的使用频率不同。疾病严重程度更高和更严重的虚弱与 COVID-19 重症老年患者 NIV 失败的风险相关。与主要 NIV 相比，主要 IMV 与更好的结局相关。临床试验注册 NCT04321265，于 2020 年 3 月 19 日注册，https://clinicaltrials.gov。
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