• Claire Dupuis, Lila Bouadma, Etienne de Montmollin, Dany Goldgran-Toledano, Carole Schwebel, Jean Reignier, Mathilde Neuville, Moreno Ursino, Shidasp Siami, Stéphane Ruckly, Corinne Alberti, Bruno Mourvillier, Sébastien Bailly, Kévin Grapin, Virginie Laurent, Niccolo Buetti, Marc Gainnier, Bertrand Souweine, and Jean-François Timsit.
• Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France.
• Crit Care Explor. 2021 Jan 1; 3 (1): e0329.

ObjectivesAbout 5% of patients with coronavirus disease-2019 are admitted to the ICU for acute hypoxemic respiratory failure. Opinions differ on whether invasive mechanical ventilation should be used as first-line therapy over noninvasive oxygen support. The aim of the study was to assess the effect of early invasive mechanical ventilation in coronavirus disease-2019 with acute hypoxemic respiratory failure on day-60 mortality.DesignMulticenter prospective French observational study.SettingEleven ICUs of the French OutcomeRea network.PatientsCoronavirus disease-2019 patients with acute hypoxemic respiratory failure (Pao2/Fio2 ≤ 300 mm Hg), without shock or neurologic failure on ICU admission, and not referred from another ICU or intermediate care unit were included.InterventionWe compared day-60 mortality in patients who were on invasive mechanical ventilation within the first 2 calendar days of the ICU stay (early invasive mechanical ventilation group) and those who were not (nonearly invasive mechanical ventilation group). We used a Cox proportional-hazard model weighted by inverse probability of early invasive mechanical ventilation to determine the risk of death at day 60.Measurement And Main ResultsThe 245 patients included had a median (interquartile range) age of 61 years (52-69 yr), a Simplified Acute Physiology Score II score of 34 mm Hg (26-44 mm Hg), and a Pao2/Fio2 of 121 mm Hg (90-174 mm Hg). The rates of ICU-acquired pneumonia, bacteremia, and the ICU length of stay were significantly higher in the early (n = 117 [48%]) than in the nonearly invasive mechanical ventilation group (n = 128 [52%]), p < 0.01. Day-60 mortality was 42.7% and 21.9% in the early and nonearly invasive mechanical ventilation groups, respectively. The weighted model showed that early invasive mechanical ventilation increased the risk for day-60 mortality (weighted hazard ratio =1.74; 95% CI, 1.07-2.83, p=0.03).ConclusionsIn ICU patients admitted with coronavirus disease-2019-induced acute hypoxemic respiratory failure, early invasive mechanical ventilation was associated with an increased risk of day-60 mortality. This result needs to be confirmed.Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.

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