Puri Chahat, Duddu Akshay, Patel Gina, Singh Sahib, Negrin Juan, Greenburg Lauren, Vitberg David, Carr Elisabeth M
Department of Pulmonary and Critical Care, University of Arizona, Phoenix, AZ, USA.
Department of Internal Medicine, Greater Baltimore Medical Center, Towson, MD, USA.
J Community Hosp Intern Med Perspect. 2025 Jul 3;15(4):14-20. doi: 10.55729/2000-9666.1499. eCollection 2025.
The COVID-19 pandemic caused a major burden on the healthcare system. Since the beginning of the pandemic, the timing of intubation in patients with COVID-19 induced acute respiratory distress syndrome (ARDS) remained an area of debate.
Does a trial of non-invasive ventilation (NIV) in COVID-19 patients worsen mortality in patients intubated due to ARDS?
A single-center, retrospective cohort study of all adult patients (n = 161) with COVID-19 admitted to the ICU between March 2020 through September 2022 with acute hypoxic respiratory failure were included. The group was divided into patients intubated after a trial of NIV (N = 100) and patients intubated without a trial of NIV (N = 61). The primary outcome was to compare the mortality rates between the two groups.
ICU mortality (defined as death during ICU admission) was higher in patients intubated after a trial of the NIV group compared to those without a trial of NIV (69% vs 52%, p = 0.044). Patients initially treated with a trial of NIV had an odds ratio (OR) of 2.17 for mortality compared to those intubated without a trial of NIV (95% CI 1.04-4.54). ICU length of stay was higher in the intubation after a trial of the NIV group, 11.9 vs 7.7 days (p = 0.001). Patients intubated after a trial of NIV had a longer hospital Length of stay (LOS) (IRR 1.39, 95% CI 1.05-1.85, p = 0.022). However, the duration of mechanical ventilation was similar in the two groups (IRR 1.23, 95% CI 1.93-4.68, p = 0.35). The incidence of pneumothorax, ventilator associated pneumonia (VAP), and venous thromboembolism (VTE) were similar in the two groups.
In ARDS, a lung protective strategy with low TV has been proven to improve patient outcomes. The use of a trial of NIV prior to intubation is associated with an increase in mortality.
新冠疫情给医疗系统带来了巨大负担。自疫情开始以来，新冠病毒诱导的急性呼吸窘迫综合征（ARDS）患者的插管时机一直存在争议。
对新冠患者进行无创通气（NIV）试验是否会增加因ARDS插管患者的死亡率？
对2020年3月至2022年9月期间入住重症监护病房（ICU）的所有成年新冠患者（n = 161）进行单中心回顾性队列研究，这些患者均患有急性低氧性呼吸衰竭。将患者分为接受NIV试验后插管的患者（N = 100）和未接受NIV试验直接插管的患者（N = 61）。主要结果是比较两组的死亡率。
与未接受NIV试验的患者相比，接受NIV试验后插管的患者ICU死亡率（定义为ICU住院期间死亡）更高（69% 对52%，p = 0.044）。与未接受NIV试验直接插管的患者相比，最初接受NIV试验治疗的患者死亡比值比（OR）为2.17（95% CI 1.04 - 4.54）。接受NIV试验后插管组的ICU住院时间更长，分别为11.9天和7.7天（p = 0.001）。接受NIV试验后插管的患者住院时间更长（住院时间比值比1.39，95% CI 1.05 - 1.85，p = 0.022）。然而，两组的机械通气时间相似（住院时间比值比1.23，95% CI 1.93 - 4.68，p = 0.35）。两组气胸、呼吸机相关性肺炎（VAP）和静脉血栓栓塞（VTE）的发生率相似。
在ARDS中，低潮气量的肺保护策略已被证明可改善患者预后。插管前进行NIV试验与死亡率增加有关。
