Association of Time-Varying Intensity of Ventilation With Mortality in Patients With COVID-19 ARDS: Secondary Analysis of the PRoVENT-COVID Study.

Fecha de publicación: 18/11/2021 Fecha Ahead of Print: 18/11/2021

Autores de IIS La Fe

Guido Mazzinari

Autor

Participantes ajenos a IIS La Fe

Schuijt MTU
van Meenen DMP
Martin-Loeches I
Schultz MJ
Paulus F
Serpa Neto A

Grupos

Medicina Perioperatoria, Anestesiología y Reanimación

Leader

Óscar Díaz Cambronero

Abstract

Background: High intensity of ventilation has an association with mortality in patients with acute respiratory failure. It is uncertain whether similar associations exist in patients with acute respiratory distress syndrome (ARDS) patients due to coronavirus disease 2019 (COVID-19). We investigated the association of exposure to different levels of driving pressure ( P) and mechanical power (MP) with mortality in these patients. Methods: PRoVENT-COVID is a national, retrospective observational study, performed at 22 ICUs in the Netherlands, including COVID-19 patients under invasive ventilation for ARDS. Dynamic P and MP were calculated at fixed time points during the first 4 calendar days of ventilation. The primary endpoint was 28-day mortality. To assess the effects of time-varying exposure, Bayesian joint models adjusted for confounders were used. Results: Of 1,122 patients included in the PRoVENT-COVID study, 734 were eligible for this analysis. In the first 28 days, 29.2% of patients died. A significant increase in the hazard of death was found to be associated with each increment in P (HR 1.04, 95% CrI 1.01-1.07) and in MP (HR 1.12, 95% CrI 1.01-1.36). In sensitivity analyses, cumulative exposure to higher levels of P or MP resulted in increased risks for 28-day mortality. Conclusion: Cumulative exposure to higher intensities of ventilation in COVID-19 patients with ARDS have an association with increased risk of 28-day mortality. Limiting exposure to high P or MP has the potential to improve survival in these patients. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT04346342.

Datos de la publicación

ISSN/ISSNe:: 2296-858X, 2296-858X
Tipo:: Article
Páginas:: 725265-725265
DOI:: 10.3389/fmed.2021.725265
Factor de Impacto:: 1,179 SCImago ℠
Cuartil:: Q1 SCImago ℠

Documentos

No hay documentos

Métricas

Filiaciones

Schuijt MTU:: Department of Intensive Care, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
van Meenen DMP:: Department of Intensive Care, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
Martin-Loeches I:: Department of Clinical Medicine, Trinity Centre for Health Sciences, Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital, Dublin, Ireland
Mazzinari G:: Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
Schultz MJ:: Department of Intensive Care, Amsterdam UMC, Location AMC, Amsterdam, Netherlands

Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand

Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
Paulus F:: Department of Intensive Care, Amsterdam UMC, Location AMC, Amsterdam, Netherlands

ACHIEVE, Centre of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, Netherlands
Serpa Neto A:: Department of Intensive Care, Amsterdam UMC, Location AMC, Amsterdam, Netherlands

Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, VIC, Australia

Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia

Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Melbourne, VIC, Australia

Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia

Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Pãulo, Brazil