Association of intensity of ventilation with 28-day mortality in COVID-19 patients with acute respiratory failure: insights from the PRoVENT-COVID study
M.T.U. Schuijt, Marcus J. Schultz, Frederique Paulus, Ary Serpa Neto, for the PRoVENT–COVID Collaborative Group, J.P. van Akkeren, Anna Geke Algera, C.K. Algoe, Rombout B. E. van Amstel, O Baur, P. van de Berg, D. C. J. J. Bergmans, D.I. van den Bersselaar, F.A. Bertens, Alexander J. G. H. Bindels, M.M. de Boer, Sylvia den Boer, L.S. Boers, Margriet Bogerd, Lieuwe D. J. Bos, Michela Botta, Jennifer S. Breel, H. de Bruin, Sanne de Bruin, C.L. Bruna, Laura A. Buiteman‐Kruizinga, Olaf L. Cremer, R.M. Determann, Willem Dieperink, Dave A. Dongelmans, H.S. Franke, Melissa Aldridge, Mart J. de Graaff, Laura A. Hagens, Jasper J. Haringman, Nanon F. L. Heijnen, S.J.P. Hiel, S.T. van der Heide, Pim L. J. van der Heiden, Lotte Hoeijmakers, Liselotte Hol, Markus W. Hollmann, Marga Hoogendoorn, Janneke Horn, R. van der Horst, E.L.K. Ie, D. Ivanov, Nicole P. Juffermans, Eline Kho, Eline S. de Klerk, Ankie Koopman, Matty Koopmans, Songul Kucukcelebi, Michaël Kuiper, Dylan W. de Lange, David M. van Meenen, Ignacio Martín‐Loeches, Guido Mazzinari, Niels van Mourik, Sunny G. L. H. Nijbroek, Marisa Onrust, Evelien Oostdijk, Frederique Paulus, C.J. Pennartz, Janesh Pillay, Luigi Pisani, Ilse M. Purmer, Thijs C. D. Rettig, J. P. Roozeman, M.T.U. Schuijt, Marcus J. Schultz, Ary Serpa Neto, M. E. Sleeswijk, Marry R. Smit, Peter E. Spronk, Willemke Stilma, Aart C. Strang, Anissa M. Tsonas, Pieter R. Tuinman, Christel M. A. Valk, F. L. van VEEN, Alexander P. J. Vlaar, Lars I. Veldhuis, Patricia van Velzen, Ward H. van der Ven, P. van Vliet, Pepijn van der Voort, H. H. van der Wier, L. van Welie, H.J.F.T. Wesselink, B. van Wijk, Tineke Winters, Wing Yi Wong, Arthur R. H. van Zanten
Abstract
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).