• Kamil Polok, Jakub Fronczek, Antonio Artigas, Hans Flaatten, Bertrand Guidet, Dylan W De Lange, Jesper Fjølner, Susannah Leaver, Michael Beil, Sigal Sviri, Raphael Romano Bruno, Bernhard Wernly, Bollen PintoBernardoBDepartment of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland., Joerg C Schefold, Dorota Studzińska, Michael Joannidis, Sandra Oeyen, Brian Marsh, Finn H Andersen, Rui Moreno, Maurizio Cecconi, Christian Jung, Wojciech Szczeklik, and COVIP Study Group.
• Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30 - 901, Kraków, Poland.
• Crit Care. 2022 Jul 22; 26 (1): 224224.

BackgroundNoninvasive 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.MethodsThis 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.ResultsCohort 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).ConclusionsFrequency 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 .© 2022. The Author(s).

19 keywords...

hide…