在新冠疫情之前及期间，欧洲重症监护病房中初始接受无创通气治疗的≥80岁呼吸衰竭患者的治疗结果。

Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic.

作者信息

Polok Kamil, Fronczek Jakub, Guidet Bertrand, Artigas Antonio, De Lange Dylan W, Fjølner Jesper, Leaver Susannah, Beil Michael, Sviri Sigal, Bruno Raphael Romano, Wernly Bernhard, Pinto Bernardo Bollen, Schefold Joerg C, Studzińska Dorota, Joannidis Michael, Oeyen Sandra, Marsh Brian, Andersen Finn H, Moreno Rui, Cecconi Maurizio, Flaatten Hans, Jung Christian, Szczeklik Wojciech

机构信息

Center 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.

出版信息

Ann Intensive Care. 2023 Sep 12;13(1):82. doi: 10.1186/s13613-023-01173-2.

DOI:10.1186/s13613-023-01173-2

PMID:37698708

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10497468/

Abstract

BACKGROUND

Non-invasive ventilation (NIV) has been commonly used to treat acute respiratory failure due to COVID-19. In this study we aimed to compare outcomes of older critically ill patients treated with NIV before and during the COVID-19 pandemic.

METHODS

We analysed a merged cohort of older adults admitted to intensive care units (ICUs) due to respiratory failure. Patients were enrolled into one of two prospective observational studies: before COVID-19 (VIP2-2018 to 2019) and admitted due to COVID-19 (COVIP-March 2020 to January 2023). The outcomes included: 30-day mortality, intubation rate and NIV failure (death or intubation within 30 days).

RESULTS

The final cohort included 1986 patients (1292 from VIP2, 694 from COVIP) with a median age of 83 years. NIV was used as a primary mode of respiratory support in 697 participants (35.1%). ICU admission due to COVID-19 was associated with an increased 30-day mortality (65.5% vs. 36.5%, HR 2.18, 95% CI 1.71 to 2.77), more frequent intubation (36.9% vs. 17.5%, OR 2.63, 95% CI 1.74 to 3.99) and NIV failure (76.2% vs. 45.3%, OR 4.21, 95% CI 2.84 to 6.34) compared to non-COVID causes of respiratory failure. Sensitivity analysis after exclusion of patients in whom life supporting treatment limitation was introduced during primary NIV confirmed higher 30-day mortality in patients with COVID-19 (52.5% vs. 23.4%, HR 2.64, 95% CI 1.83 to 3.80).

CONCLUSION

The outcomes of patients aged ≥80 years treated with NIV during COVID-19 pandemic were worse compared then those treated with NIV in the pre-pandemic era.

摘要

背景

无创通气（NIV）已被广泛用于治疗新型冠状病毒肺炎（COVID-19）所致的急性呼吸衰竭。在本研究中，我们旨在比较COVID-19大流行之前和期间接受NIV治疗的老年危重症患者的结局。

方法

我们分析了因呼吸衰竭入住重症监护病房（ICU）的老年患者合并队列。患者被纳入两项前瞻性观察性研究之一：COVID-19之前（VIP2-2018至2019年）和因COVID-19入院（COVIP-2020年3月至2023年1月）。结局包括：30天死亡率、插管率和NIV失败（30天内死亡或插管）。

结果

最终队列包括1986例患者（VIP2组1292例，COVIP组694例），中位年龄83岁。697名参与者（35.1%）将NIV用作主要呼吸支持模式。与非COVID-19导致的呼吸衰竭相比，因COVID-19入住ICU与30天死亡率增加（65.5%对36.5%，HR 2.18，95%CI 1.71至2.77）、更频繁的插管（36.9%对17.5%，OR 2.63，95%CI 1.74至3.99）和NIV失败（76.2%对45.3%，OR 4.21，95%CI 2.84至6.34）相关。在排除初次NIV期间引入生命支持治疗限制的患者后进行的敏感性分析证实，COVID-19患者的30天死亡率更高（52.5%对23.4%，HR 2.64，95%CI 1.83至3.80）。