Duration of noninvasive continuous positive airway pressure as a risk factor for mortality in patients with COVID-19 acute respiratory failure in Critical Care
2022
ASL Vercelli
AOU Alessandria
ASL Novara
Tipo pubblicazione
Conference Abstract
Autori/Collaboratori (10)Vedi tutti...
Vaschetto R
Navalesi P
Della Corte F
et alii...
Abstract
Introduction: Recent experiences suggest that noninvasive continuous positive airway pressure (CPAP) ventilation may be an effective alternative to mechanical ventilation in COVID-19 respiratory failure. However, in patients who failed CPAP, delayed intubation may increase the risk of mortality. We made a comparison between the patients admitted during the first and the second wave of the pandemic who failed CPAP and required mechanical ventilation. Methods: We retrospectively included all consecutive patients admitted to one of the four participating hospitals from March 1st to April 15th, 2020, and from November 1st to December 15th, 2020, with the following inclusion criteria: (1) age ? 18 years, (2) diagnosis of moderate to severe COVID-19 pneumonia treated with CPAP outside ICU, (3) intubation after CPAP failure. Patients who received post-extubation CPAP were excluded. We collected data about CPAP duration prior intubation, hospital length of stay and in-hospital mortality. Results: A total of 193 COVID-19 patients received intubation after CPAP failure during the first (n = 127) and the second (n = 66) wave. During the second wave, CPAP treatment was longer (4 (2-8) vs. 3 (2-5) days; p < 0.05) as well as hospital length of stay (20 (15-29) vs. 12 (6-30) days; p < 0.05) with an increased in-hospital mortality (62% vs. 35%; p < 0.001). The univariable analysis showed that CPAP duration was a risk factor for mortality in patients failing CPAP during the second wave and in the overall population [HR 1.080 (95% C.I. 1.007- 1.159) and HR 1.071 (95% C.I. 1.032-1.112), respectively. The multivariable model adjusted for centre, wave, age, gender, comorbidity, white blood cell count, and creatinine confirmed this results HR 1.117 (95% C.I. 1.029-1.214) during the second wave, and HR 1.077 (95% C.I. 1.025-1.131) in the overall patients. Conclusions: Our results confirmed that in COVID-19 patients failing CPAP performed outside ICU the risk of death increased wi
DOI : 10.1186/s13054-022-03927-z
Keywords
treatment failure; risk factor; retrospective study; noninvasive ventilation; multicenter study; male; mortality; major clinical study; leukocyte count; length of stay; intubation; in-hospital mortality; human; gender; female; coronavirus disease 2019; extubation; continuous positive airway pressure; controlled study; conference abstract; comorbidity; adult; acute respiratory failure; creatinine;