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

Critical Care

Elena Sandoval¹  Pedro David Wendel-Garcia²  Óscar Peñuelas³  Rafael Fernández⁴  Arturo Huerta⁵  Jorge Echevarria⁶  Mauricio Valencia⁷  Melcior Martínez⁸  Pau Garro⁹  José Luis Lopera^1,10  Paula Saludes^1,11  Josep Trenado^1,12  Imma Vallverdú^1,13  Carme Barberà^1,14  Josep-Maria Sirvent^1,15  Mercedes Ibarz^1,16  María Bodí^1,17  Paula Vera^1,18  Jordi Mancebo^1,19  Joan Carles Yébenes-Reyes^2,20  Arantxa Mas^2,21  Fernanda Bodí^2,22  Anna Baró^2,23  Ferran Roche-Campo^2,24  Joan-Ramon Masclans^2,25  Carles Triginer^2,26  Rafael Máñez^2,27  Ricard Ferrer^2,28  Cristina González-Isern^2,29  Francisco José Cambra^3,30 

[1] Cardiovascular Surgery Department, Hospital Clínic de Barcelona, Barcelona, Spain;Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland;Intensive Care Department Hospital, Universitario de Getafe, CIBER Enfermedades Respiratorias, CIBERES (Spain), Madrid, Spain;Intensive Care Department, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain;Intensive Care Department, Clínica Sagrada Família, Barcelona, Spain;Intensive Care Department, Hospital ASEPEYO de Barcelona, Sant Cugat del Vallés, Spain;Intensive Care Department, Hospital El Pilar - Grup Quirónsalut, Barcelona, Spain;Intensive Care Department, Hospital General De Cataluña, Sant Cugat del Vallès, Spain;Intensive Care Department, Hospital General de Granollers, Granollers, Spain;Intensive Care Department, Hospital General de Vic, Consorci Hospitalari de Vic, Vic, Spain;Intensive Care Department, Hospital HM Delfos, Barcelona, Spain;Intensive Care Department, Hospital Mútua de Terrassa, Terrassa, Spain;Intensive Care Department, Hospital Sant Joan de Reus, Reus, Spain;Intensive Care Department, Hospital Santa Maria, Lleida, Spain;Intensive Care Department, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain;Intensive Care Department, Hospital Universitari Sagrat Cor - Grup Quirónsalut, Barcelona, Spain;Intensive Care Department, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain;Intensive Care Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain;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;Intensive Care Department, Hospital de Mataró, Mataró, Spain;Intensive Care Department, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain;Intensive Care Department, Hospital de Sant Pau I Santa Tecla, Tarragona, Spain;Intensive Care Department, Hospital de Santa Caterina, Salt, Spain;Intensive Care Department, Hospital de Tortosa Verge de La Cinta, Tortosa, Spain;Intensive Care Department, Hospital del Mar, GREPAC Research Group - IMIM, Department Ciències, Experimentals I de La Salut (DCEXS) UPF, Barcelona, Spain;Intensive Care Department, Hospital d’Igualada, Igualada, Spain;Intensive Care Department, L’Hospitalet de Llobregat, Barcelona, Spain;Intensive Care Department/SODIR Research Group, Hospital Universitari General de La Vall d’Hebron, Barcelona, Spain;Medical Technology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain;Pediatric Intensive Care Department, Hospital Sant Joan de Déu de Barcelona, Esplugues de Llobregat, Spain;

关键词: COVID-19;    Intensive care;    Non-invasive oxygenation;    Acute hypoxemic respiratory failure;   

DOI  :  10.1186/s13054-022-03905-5

来源: Springer

【 摘 要 】

BackgroundNon-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.MethodsIn 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.ResultsOf 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.ConclusionIn 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.

【 授权许可】

CC BY