Non-invasive oxygenation support in acutely hypoxemic COVID-19 patients admitted to the ICU: a multicenter observational retrospective study
Por:
Wendel-Garcia PD, Mas A, González-Isern C, Ferrer R, Máñez R, Masclans JR, Sandoval E, Vera P, Trenado J, Fernández R, Sirvent JM, Martínez M, Ibarz M, Garro P, Lopera JL, Bodí M, Yébenes-Reyes JC, Triginer C, Vallverdú I, Baró A, Bodí F, Saludes P, Valencia M, Roche-Campo F, Huerta A, Cambra-Lasaosa FJ, Barberà C, Echevarria J, Peñuelas Ó, Mancebo J and UCIsCAT study group
Publicada:
8 feb 2022
Categoría:
Critical care and intensive care medicine
Resumen:
Background Non-invasive oxygenation strategies have a prominent role in the treatment of acute hypoxemic respiratory failure during the coronavirus disease 2019 (COVID-19). While the efficacy of these therapies has been studied in hospitalized patients with COVID-19, the clinical outcomes associated with oxygen masks, high-flow oxygen therapy by nasal cannula and non-invasive mechanical ventilation in critically ill intensive care unit (ICU) patients remain unclear. Methods In this retrospective study, we used the best of nine covariate balancing algorithms on all baseline covariates in critically ill COVID-19 patients supported with > 10 L of supplemental oxygen at one of the 26 participating ICUs in Catalonia, Spain, between March 14 and April 15, 2020. Results Of the 1093 non-invasively oxygenated patients at ICU admission treated with one of the three stand-alone non-invasive oxygenation strategies, 897 (82%) required endotracheal intubation and 310 (28%) died during the ICU stay. High-flow oxygen therapy by nasal cannula (n = 439) and non-invasive mechanical ventilation (n = 101) were associated with a lower rate of endotracheal intubation (70% and 88%, respectively) than oxygen masks (n = 553 and 91% intubated), p < 0.001. Compared to oxygen masks, high-flow oxygen therapy by nasal cannula was associated with lower ICU mortality (hazard ratio 0.75 [95% CI 0.58-0.98), and the hazard ratio for ICU mortality was 1.21 [95% CI 0.80-1.83] for non-invasive mechanical ventilation. Conclusion In critically ill COVID-19 ICU patients and, in the absence of conclusive data, high-flow oxygen therapy by nasal cannula may be the approach of choice as the primary non-invasive oxygenation support strategy.
Filiaciones:
Wendel-Garcia PD:
Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
Mas A:
Intensive Care Department, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain
González-Isern C:
Medical Technology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
Ferrer R:
Intensive Care Department/SODIR Research Group, Hospital Universitari General de La Vall d'Hebron, Barcelona, Spain
Máñez R:
Intensive Care Department, L'Hospitalet de Llobregat, Barcelona, Spain
Masclans JR:
Intensive Care Department, Hospital del Mar, GREPAC Research Group - IMIM, Department Ciències, Experimentals I de La Salut (DCEXS) UPF, Barcelona, Spain
Sandoval E:
Cardiovascular Surgery Department, Hospital Clínic de Barcelona, Barcelona, Spain
Vera P:
Intensive Care Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
Trenado J:
Intensive Care Department, Hospital Mútua de Terrassa, Terrassa, Spain
Fernández R:
Intensive Care Department, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain
Sirvent JM:
Intensive Care Department, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
Martínez M:
Intensive Care Department, Hospital General De Cataluña, Sant Cugat del Vallès, Spain
Ibarz M:
Intensive Care Department, Hospital Universitari Sagrat Cor - Grup Quirónsalut, Barcelona, Spain
Garro P:
Intensive Care Department, Hospital General de Granollers, Granollers, Spain
Lopera JL:
Intensive Care Department, Hospital General de Vic, Consorci Hospitalari de Vic, Vic, Spain
Bodí M:
Intensive Care Department, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
Yébenes-Reyes JC:
Intensive Care Department, Hospital de Mataró, Mataró, Spain
Triginer C:
Intensive Care Department, Hospital d'Igualada, Igualada, Spain
Vallverdú I:
Intensive Care Department, Hospital Sant Joan de Reus, Reus, Spain
Baró A:
Intensive Care Department, Hospital de Santa Caterina, Salt, Spain
Bodí F:
Intensive Care Department, Hospital de Sant Pau I Santa Tecla, Tarragona, Spain
Saludes P:
Intensive Care Department, Hospital HM Delfos, Barcelona, Spain
Valencia M:
Intensive Care Department, Hospital El Pilar - Grup Quirónsalut, Barcelona, Spain
Roche-Campo F:
Intensive Care Department, Hospital de Tortosa Verge de La Cinta, Tortosa, Spain
Huerta A:
Intensive Care Department, Clínica Sagrada Família, Barcelona, Spain
Cambra-Lasaosa FJ:
Pediatric Intensive Care Department, Hospital Sant Joan de Déu de Barcelona, Esplugues de Llobregat, Spain
Barberà C:
Intensive Care Department, Hospital Santa Maria, Lleida, Spain
Echevarria J:
Intensive Care Department, Hospital ASEPEYO de Barcelona, Sant Cugat del Vallés, Spain
Peñuelas Ó:
Intensive Care Department Hospital, Universitario de Getafe, CIBER Enfermedades Respiratorias, CIBERES (Spain), Madrid, Spain
Mancebo J:
Intensive Care Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain.
Institut d, Investigació Biomèdica Sant Pau, ', Servei Medicina Intensiva, Hospital Universitari Sant Pau, Barcelona, Spain.
Hosp Univ Bellvitge, Barcelona, Spain.
Hosp Clin Prov Barcelona, Barcelona, Spain.
Hosp Del Mar, Barcelona, Spain.
Hosp St Joan Despi Moises Broggi, St Joan Despi, Spain.
Hosp Mutua Terrassa, Terrassa, Spain.
Xarxa Assistencial Univ Manresa, Althaia, Manresa, Spain.
Hosp Univ Doctor Josep Trueta Girona, Girona, Spain.
Hosp Gen Cataluna, Sant Cugat Del Valles, Spain.
Hosp Univ Sagrat Cor, Grp Quironsalut, Barcelona, Spain.
Hosp Gen Granollers, Granollers, Spain.
Hosp Gen Vic, Consorci Hosp Vic 5, Vic, Spain.
Hosp Univ Tarragona Joan XXIII, Tarragona, Spain.
Hosp Mataro, Mataro, Spain.
Hosp Igualada, Igualada, Spain.
Hosp St Joan Reus, Reus, Spain.
Hosp St Caterina, Salt, Spain.
Hosp Sant Pau I Santa Tecla, Tarragona, Spain.
Hosp HM Delfos, Barcelona, Spain.
Hosp El Pilar, Grp Quironsalut, Barcelona, Spain.
Hosp Tortosa Verge La Cinta, Tortosa, Spain.
Clin Sagrada Familia, Barcelona, Spain.
Hosp St Joan Deu, Esplugas de Llobregat, Spain.
Hosp Santa Maria, Lleida, Spain.
Hosp ASEPEYO Barcelona, Sant Cugat Del Valles, Spain.
Hosp St Creu I St Pau, Barcelona, Spain.
Hosp Univ Bellvitge, Barcelona, Spain
Hosp Clin Prov Barcelona, Barcelona, Spain
Hosp del Mar, Barcelona, Spain
Hosp St Joan Despi Moises Broggi, St Joan Despi, Spain
Hosp Mutua Terrassa, Terrassa, Spain
Xarxa Assistencial Univ Manresa, Althaia, Manresa, Spain
Hosp Univ Doctor Josep Trueta Girona, Girona, Spain
Hosp Gen Cataluna, Sant Cugat Del Valles, Spain
Hosp Univ Sagrat Cor, Grp Quironsalut, Barcelona, Spain
Hosp Gen Granollers, Granollers, Spain
Hosp Gen Vic, Consorci Hosp Vic 5, Vic, Spain
Hosp Univ Tarragona Joan XXIII, Tarragona, Spain
Hosp Mataro, Mataro, Spain
Hosp Igualada, Igualada, Spain
Hosp St Joan Reus, Reus, Spain
Hosp St Caterina, Salt, Spain
Hosp Sant Pau I Santa Tecla, Tarragona, Spain
Hosp HM Delfos, Barcelona, Spain
Hosp El Pilar, Grp Quironsalut, Barcelona, Spain
Hosp Tortosa Verge La Cinta, Tortosa, Spain
Clin Sagrada Familia, Barcelona, Spain
Hosp St Joan Deu, Esplugas de Llobregat, Spain
Hosp Santa Maria, Lleida, Spain
Hosp ASEPEYO Barcelona, Sant Cugat Del Valles, Spain
Hosp St Creu I St Pau, Barcelona, Spain
Green Published, gold
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