TY - JOUR
T1 - Association of intensity of ventilation with 28-day mortality in COVID-19 patients with acute respiratory failure
T2 - insights from the PRoVENT-COVID study
AU - Schuijt, Michiel T U
AU - Schultz, Marcus J
AU - Paulus, Frederique
AU - Serpa Neto, Ary
AU - Cremer, Olaf
N1 - Funding Information:
The authors would like to state a special gratitude towards all participating centers and all members of the PRoVENT-COVID Collaborative Group. The PRoVENT-COVID Collaborative Group investigators in alphabetic order: J.P. van Akkeren; A.G. Algera; C.K. Algoe; R.B. van Amstel; O.L. Baur; P. van de Berg; A.E. van den Berg; D.C.J.J. Bergmans; D.I. van den Bersselaar; F.A. Bertens; A.J.G.H. Bindels; M.M. de Boer; S. den Boer; L.S. Boers; M. Bogerd; L.D.J. Bos; M. Botta; J.S. Breel; H. de Bruin; S. de Bruin; C.L. Bruna; L.A. Buiteman?Kruizinga; O. Cremer; R.M. Determann; W. Dieperink; D.A. Dongelmans; H.S. Franke; M.S. Galek?Aldridge; M.J. de Graaff; L.A. Hagens; J.J. Haringman; N.F.L.Heijnen; S.Hiel; S.T. van der Heide; P.L.J. van der Heiden; L.L. Hoeijmakers; L. Hol; M. W. Hollmann; M.E. Hoogendoorn; J. Horn; R. van der Horst; E.L.K. Ie; D. Ivanov; N.P. Juffermans; E. Kho; E.S. de Klerk; A.W.M. Koopman; M. Koopmans; S. Kucukcelebi; M.A. Kuiper; D.W. de Lange; D. M. van Meenen; Ignacio Martin-Loeches; Guido Mazzinari; N. van Mourik; I. Martin?Loeches; S.G. Nijbroe; M. Onrust; E.A.N. Oostdijk; F. Paulus; C.J. Pennartz; J. Pillay; L. Pisani; I.M. Purmer; T.C.D. Rettig; J.P Roozeman; M.T.U. Schuijt; M.J. Schultz; A. Serpa Neto; M.E. Sleeswijk; M.R. Smit; P.E. Spronk; W. Stilma; A.C. Strang; A. M. Tsonas; P.R Tuinman; C.M.A. Valk; F.L.Veen; A.P.J. Vlaar; L.I. Veldhuis; P. van Velzen; W.H. van der Ven; P. van Vliet; P. van der Voort; H.H. van der Wier; L. van Welie; H.J.F.T. Wesselink; B. van Wijk; T. Winters; W.Y. Wong; A.R.H. van Zanten.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/8/6
Y1 - 2021/8/6
N2 - Background: The intensity of ventilation, reflected by driving pressure (ΔP) and mechanical power (MP), has an association with outcome in invasively ventilated patients with or without acute respiratory distress syndrome (ARDS). It is uncertain if a similar association exists in coronavirus disease 2019 (COVID-19) patients with acute respiratory failure. Methods: We aimed to investigate the impact of intensity of ventilation on patient outcome. The PRoVENT-COVID study is a national multicenter observational study in COVID-19 patients receiving invasive ventilation. Ventilator parameters were collected a fixed time points on the first calendar day of invasive ventilation. Mean dynamic ΔP and MP were calculated for individual patients at time points without evidence of spontaneous breathing. A Cox proportional hazard model, and a double stratification analysis adjusted for confounders were used to estimate the independent associations of ΔP and MP with outcome. The primary endpoint was 28-day mortality. Results: In 825 patients included in this analysis, 28-day mortality was 27.5%. ΔP was not independently associated with mortality (HR 1.02 [95% confidence interval 0.88–1.18]; P = 0.750). MP, however, was independently associated with 28-day mortality (HR 1.17 [95% CI 1.01–1.36]; P = 0.031), and increasing quartiles of MP, stratified on comparable levels of ΔP, had higher risks of 28-day mortality (HR 1.15 [95% CI 1.01–1.30]; P = 0.028). Conclusions: In this cohort of critically ill invasively ventilated COVID-19 patients with acute respiratory failure, we show an independent association of MP, but not ΔP with 28-day mortality. MP could serve as one prognostic biomarker in addition to ΔP in these patients. Efforts aiming at limiting both ΔP and MP could translate in a better outcome. Trial registration Clinicaltrials.gov (study identifier NCT04346342). [Figure not available: see fulltext.]
AB - Background: The intensity of ventilation, reflected by driving pressure (ΔP) and mechanical power (MP), has an association with outcome in invasively ventilated patients with or without acute respiratory distress syndrome (ARDS). It is uncertain if a similar association exists in coronavirus disease 2019 (COVID-19) patients with acute respiratory failure. Methods: We aimed to investigate the impact of intensity of ventilation on patient outcome. The PRoVENT-COVID study is a national multicenter observational study in COVID-19 patients receiving invasive ventilation. Ventilator parameters were collected a fixed time points on the first calendar day of invasive ventilation. Mean dynamic ΔP and MP were calculated for individual patients at time points without evidence of spontaneous breathing. A Cox proportional hazard model, and a double stratification analysis adjusted for confounders were used to estimate the independent associations of ΔP and MP with outcome. The primary endpoint was 28-day mortality. Results: In 825 patients included in this analysis, 28-day mortality was 27.5%. ΔP was not independently associated with mortality (HR 1.02 [95% confidence interval 0.88–1.18]; P = 0.750). MP, however, was independently associated with 28-day mortality (HR 1.17 [95% CI 1.01–1.36]; P = 0.031), and increasing quartiles of MP, stratified on comparable levels of ΔP, had higher risks of 28-day mortality (HR 1.15 [95% CI 1.01–1.30]; P = 0.028). Conclusions: In this cohort of critically ill invasively ventilated COVID-19 patients with acute respiratory failure, we show an independent association of MP, but not ΔP with 28-day mortality. MP could serve as one prognostic biomarker in addition to ΔP in these patients. Efforts aiming at limiting both ΔP and MP could translate in a better outcome. Trial registration Clinicaltrials.gov (study identifier NCT04346342). [Figure not available: see fulltext.]
KW - Aged
KW - COVID-19/mortality
KW - Cohort Studies
KW - Critical Illness/mortality
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Mortality/trends
KW - Respiration, Artificial/mortality
KW - Respiratory Distress Syndrome/mortality
KW - Retrospective Studies
KW - Tidal Volume/physiology
KW - Coronavirus disease 2019
KW - Driving pressure
KW - Mortality
KW - Invasive ventilation
KW - COVID-19
KW - Mechanical power
KW - Acute respiratory failure
KW - ICU
KW - ΔP
KW - Mechanical power of ventilation
UR - http://www.scopus.com/inward/record.url?scp=85113177921&partnerID=8YFLogxK
U2 - 10.1186/s13054-021-03710-6
DO - 10.1186/s13054-021-03710-6
M3 - Article
C2 - 34362415
SN - 1466-609X
VL - 25
JO - Critical care (London, England)
JF - Critical care (London, England)
IS - 1
M1 - 283
ER -