Abstract
Background: Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV.
Methods: This is a substudy of COVIP study-an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality.
Results: Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36-5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06-2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI – 2.27 to – 0.46 days) compared to primary IMV group (n = 1876).
Conclusions: Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV. Clinical Trial Registration NCT04321265 , registered 19 March 2020, https://clinicaltrials.gov .
Keywords: COVID-19; Elderly; Frailty; Intensive care unit; Noninvasive ventilation.
【저자키워드】 COVID-19, elderly, intensive care unit, frailty, Noninvasive ventilation., 【초록키워드】 Europe, intensive care, prospective observational study, COVID-19 pandemic, severity, Ventilation, risk, outcome, ICU, Registration, Critically ill, clinical, International, male, Patient, ICU admission, death, age, SOFA, scale, assessment, Admission, Care, patients, 30-Day mortality, Invasive mechanical ventilation, Frequency, primary endpoint, Endotracheal intubation, Older, Factor, 95% CI, failure, Registered, CFS, NIV, European, IMV, European country, enrolled, defined, evaluate, occurred, treated, the mean, patients treated, with COVID-19, 【제목키워드】 Ventilation, cohort study, multicentre, COVID-19 patient,