• Vikram B Gondhalekar, Amir Gandomi, Sarah L Gilman, Negin Hajizadeh, Zubair M Hasan, Matthew A Bank, Daniel M Rolston, Allison Cohen, Timmy Li, Mitsuaki Nishikimi, Mangala Narasimhan, Lance Becker, and Daniel Jafari.
• Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY.
• Crit. Care Med. 2024 Jul 1; 52 (7): 102110311021-1031.

ObjectivesNonconventional ventilators (NCVs), defined here as transport ventilators and certain noninvasive positive pressure devices, were used extensively as crisis-time ventilators for intubated patients with COVID-19. We assessed whether there was an association between the use of NCV and higher mortality, independent of other factors.DesignThis is a multicenter retrospective observational study.SettingThe sample was recruited from a single healthcare system in New York. The recruitment period spanned from March 1, 2020, to April 30, 2020.PatientsThe sample includes patients who were intubated for COVID-19 acute respiratory distress syndrome (ARDS).InterventionsNone.Measurements And Main ResultsThe primary outcome was 28-day in-hospital mortality. Multivariable logistic regression was used to derive the odds of mortality among patients managed exclusively with NCV throughout their ventilation period compared with the remainder of the sample while adjusting for other factors. A secondary analysis was also done, in which the mortality of a subset of the sample exclusively ventilated with NCV was compared with that of a propensity score-matched subset of the control group. Exclusive use of NCV was associated with a higher 28-day in-hospital mortality while adjusting for confounders in the regression analysis (odds ratio, 1.41; 95% CI [1.07-1.86]). In the propensity score matching analysis, the mortality of patients exclusively ventilated with NCV was 68.9%, and that of the control was 60.7% ( p = 0.02).ConclusionsUse of NCV was associated with increased mortality among patients with COVID-19 ARDS. More lives may be saved during future ventilator shortages if more full-feature ICU ventilators, rather than NCVs, are reserved in national and local stockpiles.Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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