Articles producció científica> Medicina i Cirurgia

Non-invasive oxygenation support in acutely hypoxemic COVID-19 patients admitted to the ICU: a multicenter observational retrospective study

  • Identification data

    Identifier: imarina:9246565
    Authors:
    Wendel-Garcia, Pedro DavidMas, ArantxaGonzalez-Isern, CristinaFerrer, RicardManez, RafaelMasclans, Joan-RamonSandoval, ElenaVera, PaulaTrenado, JosepFernandez, RafaelSirvent, Josep-MariaMartinez, MelciorIbarz, MercedesGarro, PauLopera, Jose LuisBodi, MariaYebenes-Reyes, Joan CarlesTriginer, CarlesVallverdu, ImmaBaro, AnnaBodi, FernandaSaludes, PaulaValencia, MauricioRoche-Campo, FerranHuerta, ArturoCambra, Francisco JoseBarbera, CarmeEchevarria, JorgePenuelas, OscarMancebo, Jordi
    Abstract:
    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.
  • Others:

    Author, as appears in the article.: Wendel-Garcia, Pedro David; Mas, Arantxa; Gonzalez-Isern, Cristina; Ferrer, Ricard; Manez, Rafael; Masclans, Joan-Ramon; Sandoval, Elena; Vera, Paula; Trenado, Josep; Fernandez, Rafael; Sirvent, Josep-Maria; Martinez, Melcior; Ibarz, Mercedes; Garro, Pau; Lopera, Jose Luis; Bodi, Maria; Yebenes-Reyes, Joan Carles; Triginer, Carles; Vallverdu, Imma; Baro, Anna; Bodi, Fernanda; Saludes, Paula; Valencia, Mauricio; Roche-Campo, Ferran; Huerta, Arturo; Cambra, Francisco Jose; Barbera, Carme; Echevarria, Jorge; Penuelas, Oscar; Mancebo, Jordi
    Department: Medicina i Cirurgia
    URV's Author/s: Bodi Saera, Maria Amparo / Rodríguez Oviedo, Alejandro Hugo
    Keywords: Non-invasive oxygenation Intensive care Covid-19 Acute hypoxemic respiratory failure
    Abstract: 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.
    Thematic Areas: Saúde coletiva Nutrição Medicina veterinaria Medicina iii Medicina ii Medicina i Interdisciplinar Farmacia Engenharias iv Enfermagem Educação física Critical care medicine Critical care and intensive care medicine Ciências biológicas iii Ciências biológicas ii Ciências biológicas i Ciência de alimentos Biotecnología
    licence for use: https://creativecommons.org/licenses/by/3.0/es/
    Author's mail: alejandrohugo.rodriguez@urv.cat mariaamparo.bodi@urv.cat mariaamparo.bodi@urv.cat
    Author identifier: 0000-0001-8828-5984 0000-0001-7652-8379 0000-0001-7652-8379
    Record's date: 2025-01-27
    Paper version: info:eu-repo/semantics/publishedVersion
    Licence document URL: https://repositori.urv.cat/ca/proteccio-de-dades/
    Paper original source: Critical Care. 26 (37): 1-13
    APA: Wendel-Garcia, Pedro David; Mas, Arantxa; Gonzalez-Isern, Cristina; Ferrer, Ricard; Manez, Rafael; Masclans, Joan-Ramon; Sandoval, Elena; Vera, Paula; (2022). Non-invasive oxygenation support in acutely hypoxemic COVID-19 patients admitted to the ICU: a multicenter observational retrospective study. Critical Care, 26(37), 1-13. DOI: 10.1186/s13054-022-03905-5
    Entity: Universitat Rovira i Virgili
    Journal publication year: 2022
    Publication Type: Journal Publications
  • Keywords:

    Critical Care and Intensive Care Medicine,Critical Care Medicine
    Non-invasive oxygenation
    Intensive care
    Covid-19
    Acute hypoxemic respiratory failure
    Saúde coletiva
    Nutrição
    Medicina veterinaria
    Medicina iii
    Medicina ii
    Medicina i
    Interdisciplinar
    Farmacia
    Engenharias iv
    Enfermagem
    Educação física
    Critical care medicine
    Critical care and intensive care medicine
    Ciências biológicas iii
    Ciências biológicas ii
    Ciências biológicas i
    Ciência de alimentos
    Biotecnología
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