Noninvasive ventilation in COVID-19 patients aged ≥ 70 years—a prospective multicentre cohort study

Kamil Polok , Jakub Fronczek , Antonio Artigas , Hans Flaatten , Bertrand Guidet (1) , Dylan de Lange , Jesper Fjølner , Susannah Leaver , Michael Beil , Sigal Sviri , Raphael Romano Bruno , Bernhard Wernly , Bernardo Bollen Pinto , Joerg Schefold , Dorota Studzińska , Michael Joannidis , Sandra Oeyen , Brian Marsh , Finn Andersen , Rui Moreno , Maurizio Cecconi , Christian Jung , Wojciech Szczeklik , Philipp Eller , Michael Joannidis , Dieter Mesotten , Pascal 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 , Aliae Hussein , Rehab Salah , Yasmin Khairy Nasreldin Mohamed Ali , Kyrillos Wassim , Yumna Elgazzar , Samar Tharwat , Ahmed Azzam , Ayman Abdelmawgoad Habib , Hazem Maarouf Abosheaishaa , Mohammed Azab , Susannah Leaver , Arnaud Galbois , Bertrand Guidet , Cyril Charron , Emmanuel Guerot , Guillaume Besch , Jean-Philippe Rigaud , Julien Maizel , Michel Djibré , Philippe Burtin , Pierre Garcon , Saad Nseir , Xavier Valette , Nica Alexandru , Nathalie Marin , Marie Vaissiere , Gaëtan Plantefeve , Thierry Vanderlinden , Igor Jurcisin , Buno Megarbane (2) , Anais Caillard , Arnaud Valent , Marc Garnier , Sebastien Besset , Johanna Oziel , Jean-Herlé Raphalen , Stéphane Dauger , Guillaume Dumas , Bruno Goncalves , Gaël Piton , Eberhard Barth , Ulrich Goebel , Eberhard Barth , Anselm Kunstein , Michael Schuster , Martin Welte , Matthias Lutz , Patrick Meybohm , Stephan Steiner , Tudor Poerner , Hendrik Haake , Stefan Schaller , Stefan Schaller , Stefan Schaller , Detlef Kindgen-Milles , Christian Meyer , Muhammed Kurt , Karl Friedrich Kuhn , Winfried Randerath , Jakob Wollborn , Zouhir Dindane , Hans-Joachim Kabitz , Ingo Voigt , Gonxhe Shala , Andreas Faltlhauser , Nikoletta Rovina , Zoi Aidoni , Evangelia Chrisanthopoulou , Antonios Papadogoulas , Mohan Gurjar , Ata Mahmoodpoor , Abdullah Khudhur Ahmed , Brian Marsh , Ahmed Elsaka , Sigal Sviri , Vittoria Comellini , Ahmed Rabha , Hazem Ahmed , Silvio Namendys-Silva , Abdelilah Ghannam , Martijn Groenendijk , Marieke Zegers , Dylan de Lange , Alex Cornet , Mirjam Evers , Lenneke Haas , Tom Dormans , Willem Dieperink , Luis Romundstad , Britt Sjøbø , Finn Andersen , Hans Frank Strietzel , Theresa Olasveengen , Michael Hahn , Miroslaw Czuczwar , Ryszard Gawda , Jakub Klimkiewicz , Maria de Lurdes Campos Santos , André Gordinho , Henrique Santos , Rui Assis , Ana Isabel Pinho Oliveira , Mohamed Raafat Badawy , David Perez-Torres , Gemma Gomà , Mercedes Ibarz Villamayor , Angela Prado Mira , Patricia Jimeno Cubero , Susana Arias Rivera , Teresa Tomasa , David Iglesias , Eric Mayor Vázquez , Cesar Aldecoa , Aida Fernández Ferreira , Begoña Zalba-Etayo , Isabel Canas-Perez , Luis Tamayo-Lomas , Cristina Diaz-Rodriguez , Susana Sancho , Jesús Priego , Enas Abualqumboz , Momin Majed Yousuf Hilles , Mahmoud Saleh , Nawfel Ben-Hamouda , Andrea Roberti , Alexander Dullenkopf , Yvan Fleury , Bernardo Bollen Pinto , Joerg Schefold , Mohammed Al-Sadawi

1 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
2 OPTeN (UMR_S 1144 / U1144) - Optimisation thérapeutique en Neuropsychopharmacologie

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 .

Domaines: Toxicologie; Cardiologie et système cardiovasculaire; Maladies émergentes; Maladies infectieuses; Pneumologie et système respiratoire

Kamil Polok, Jakub Fronczek, Antonio Artigas, Hans Flaatten, Bertrand Guidet, et al.. Noninvasive ventilation in COVID-19 patients aged ≥ 70 years—a prospective multicentre cohort study. Critical Care, 2022, 26 (1), pp.224. ⟨10.1186/s13054-022-04082-1⟩. ⟨hal-03854528⟩