tetano
Editor, Senior Moderator
J Crit Care
. 2023 May 8;77:154322.
doi: 10.1016/j.jcrc.2023.154322. Online ahead of print. The impact of timing of initiating invasive mechanical ventilation in COVID-19-related respiratory failure
Laura C Myers[SUP] 1 [/SUP], Patricia Kipnis[SUP] 2 [/SUP], John D Greene[SUP] 2 [/SUP], Aiyu Chen[SUP] 3 [/SUP], Beth Creekmur[SUP] 3 [/SUP], Stan Xu[SUP] 3 [/SUP], Viji Sankar[SUP] 4 [/SUP], Nareg H Roubinian[SUP] 2 [/SUP], Annette Langer-Gould[SUP] 5 [/SUP], Michael K Gould[SUP] 6 [/SUP], Vincent X Liu[SUP] 2 [/SUP]
Affiliations
Purpose: Optimal timing of initiating invasive mechanical ventilation (IMV) in coronavirus disease 2019 (COVID-19)-related respiratory failure is unclear. We hypothesized that a strategy of IMV as opposed to continuing high flow oxygen or non-invasive mechanical ventilation each day after reaching a high FiO2 threshold would be associated with worse in-hospital mortality.
Methods: Using data from Kaiser Permanente Northern/Southern California's 36 medical centers, we identified patients with COVID-19-related acute respiratory failure who reached ≥80% FiO2 on high flow nasal cannula or non-invasive ventilation. Exposure was IMV initiation each day after reaching high FiO2 threshold (T[SUB]0[/SUB]). We developed propensity scores with overlap weighting for receipt of IMV each day adjusting for confounders. We reported relative risk of inpatient death with 95% Confidence Interval.
Results: Of 28,035 hospitalizations representing 21,175 patient-days, 5758 patients were included (2793 received and 2965 did not receive IMV). Patients receiving IMV had higher unadjusted mortality (63.6% versus 18.2%, P < 0.0001). On each day after reaching T[SUB]0[/SUB] through day >10, the adjusted relative risk was higher for those receiving IMV compared to those not receiving IMV (Relative Risk>1).
Conclusions: Initiation of IMV on each day after patients reach high FiO2 threshold was associated with higher inpatient mortality after adjusting for time-varying confounders. Remaining on high flow nasal cannula or non-invasive ventilation does not appear to be harmful compared to IMV. Prospective evaluation is needed.
Keywords: Coronavirus disease 2019; High flow nasal cannula; Invasive mechanical ventilation; Respiratory failure.
. 2023 May 8;77:154322.
doi: 10.1016/j.jcrc.2023.154322. Online ahead of print. The impact of timing of initiating invasive mechanical ventilation in COVID-19-related respiratory failure
Laura C Myers[SUP] 1 [/SUP], Patricia Kipnis[SUP] 2 [/SUP], John D Greene[SUP] 2 [/SUP], Aiyu Chen[SUP] 3 [/SUP], Beth Creekmur[SUP] 3 [/SUP], Stan Xu[SUP] 3 [/SUP], Viji Sankar[SUP] 4 [/SUP], Nareg H Roubinian[SUP] 2 [/SUP], Annette Langer-Gould[SUP] 5 [/SUP], Michael K Gould[SUP] 6 [/SUP], Vincent X Liu[SUP] 2 [/SUP]
Affiliations
- PMID: 37163851
- DOI: 10.1016/j.jcrc.2023.154322
Purpose: Optimal timing of initiating invasive mechanical ventilation (IMV) in coronavirus disease 2019 (COVID-19)-related respiratory failure is unclear. We hypothesized that a strategy of IMV as opposed to continuing high flow oxygen or non-invasive mechanical ventilation each day after reaching a high FiO2 threshold would be associated with worse in-hospital mortality.
Methods: Using data from Kaiser Permanente Northern/Southern California's 36 medical centers, we identified patients with COVID-19-related acute respiratory failure who reached ≥80% FiO2 on high flow nasal cannula or non-invasive ventilation. Exposure was IMV initiation each day after reaching high FiO2 threshold (T[SUB]0[/SUB]). We developed propensity scores with overlap weighting for receipt of IMV each day adjusting for confounders. We reported relative risk of inpatient death with 95% Confidence Interval.
Results: Of 28,035 hospitalizations representing 21,175 patient-days, 5758 patients were included (2793 received and 2965 did not receive IMV). Patients receiving IMV had higher unadjusted mortality (63.6% versus 18.2%, P < 0.0001). On each day after reaching T[SUB]0[/SUB] through day >10, the adjusted relative risk was higher for those receiving IMV compared to those not receiving IMV (Relative Risk>1).
Conclusions: Initiation of IMV on each day after patients reach high FiO2 threshold was associated with higher inpatient mortality after adjusting for time-varying confounders. Remaining on high flow nasal cannula or non-invasive ventilation does not appear to be harmful compared to IMV. Prospective evaluation is needed.
Keywords: Coronavirus disease 2019; High flow nasal cannula; Invasive mechanical ventilation; Respiratory failure.