Noninvasive ventilation in COVID-19 patients aged ≥ 70 years—a prospective multicentre cohort study
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, Bernardo Bollen Pinto, Joerg C. Schefold, Dorota Studzińska, Michael Joannidis, Sandra Oeyen, Brian Marsh, Finn H. Andersen, Rui P. Moreno, Maurizio Cecconi, Christian Jung, Wojciech Szczeklik, COVIP Study Group, Philipp Eller, Michael Joannidis, Dieter Mesotten, P. Reper, Sandra Oeyen, Walter Swinnen, Helene Brix, Jens Brushoej, Maja Villefrance, Helene Korvenius Nedergaard, Anders Thais Bjerregaard, Ida Riise Balleby, Kasper Andersen, Maria Aagaard Hansen, Stine Uhrenholt, Helle Bundgaard, Jesper Fjølner, Aliaë Mohamed-Hussein, Rehab Salah, Yasmin Khairy NasrEldin Mohamed Ali, Kyrillos Wassim, Yumna A Elgazzar, Samar Tharwat, Ahmed Y. Azzam, Ayman Abdelmawgoad Habib, Hazem Abosheaishaa, Mohammed A. Azab, Susannah Leaver, Arnaud Galbois, Bertrand Guidet, Cyril Charron, Emmanuel Guérot, Guillaume Besch, Jean‐Philippe Rigaud, Julien Maizel, Michel Djibré, Philippe Burtin, Pierre Garçon, Saad Nseir, Xavier Valette, Nica Alexandru, Nathalie Marin, Marie Vaissiere, Gaëtan Plantefève, Thierry Vanderlinden, Igor Jurcisin, Buno Mégarbane, Anaïs Caillard, Arnaud Valent, Marc Garnier, Sébastien Besset, Johanna Oziel, Jean‐Herlé Raphalen, Stéphane Dauger, Guillaume Dumas, Bruno Gonçalves, Gaël Piton, Eberhard Barth, Ulrich Goebel, Eberhard Barth, Anselm Kunstein, Michael Schuster, M. Welte, Matthias Lutz, Patrick Meybohm, Stephan Steiner, Tudor C. Poerner, Hendrik Haake, Stefan Schaller, Stefan J. Schaller, Stefan Schaller, Detlef Kindgen‐Milles, Christian Meyer, Muhammed Kurt, Karl Friedrich Kuhn, Winfried Randerath
Abstract
BACKGROUND: Noninvasive 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. METHODS: This 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. RESULTS: Cohort 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). CONCLUSIONS: Frequency 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 .