Critical Care Explorations (Feb 2024)

Successful Versus Failed Transition From Controlled Ventilation to Pressure Support Ventilation in COVID-19 Patients: A Retrospective Cohort Study

  • Melisa Polo Friz, MD,
  • Emanuele Rezoagli, MD,
  • Bijan Safaee Fakhr, MD,
  • Gaetano Florio, MD,
  • Eleonora Carlesso, MS,
  • Riccardo Giudici, MD,
  • Clarissa Forlini, MD,
  • Francesca Tardini, MD,
  • Thomas Langer, MD,
  • Matteo Laratta, MD,
  • Giampaolo Casella, MD,
  • Andrea Forastieri Molinari, MD,
  • Alessandro Protti, MD,
  • Maurizio Cecconi, MD,
  • Luca Cabrini, MD,
  • Emanuela Biagioni, MD,
  • Angela Berselli, MD,
  • Lucia Mirabella, MD,
  • Tommaso Tonetti, MD,
  • Edoardo De Robertis, MD,
  • Domenico Luca Grieco, MD,
  • Massimo Antonelli, MD,
  • Giuseppe Citerio, MD,
  • Roberto Fumagalli, MD,
  • Giuseppe Foti, MD,
  • Alberto Zanella, MD,
  • Giacomo Grasselli, MD,
  • Giacomo Bellani, MD,
  • for the COVID-19 Lombardy ICU Network,
  • Amedeo Guzzardella,
  • Luigi Vivona,
  • Vittorio Scaravilli,
  • Sebastiano Colombo,
  • Alessio Cacioppola,
  • Matteo Brioni,
  • Clarissa Forlini,
  • Francesca Tardini,
  • Thomas Langer,
  • Matteo Laratta,
  • Giampaolo Casella,
  • Maria Marsili,
  • Serena Stropeni,
  • Valentina Cordolcini,
  • Francesco Crimella,
  • Alessandro Santini,
  • Massimiliano Greco,
  • Michele Ferrari,
  • Giacomo Iapichino,
  • Paolo Severgnini,
  • Davide Maraggia,
  • Dario Gasberti,
  • Alessandro Motta,
  • Irene Coloretti,
  • Stefano Busani,
  • Martina Tosi,
  • Ilenia Gatto,
  • Carlo Montalto,
  • Alberto Biondo,
  • Ziad Algamain,
  • Valentina Alaimo,
  • Livio Tullo,
  • Francesco Paolo Padovano,
  • Giacinto Pizzilli,
  • Irene Cavalli,
  • Rachele Simonte,
  • Davide Valeri,
  • Gennaro DePascale,
  • Simone Carelli,
  • Valentina Noseda,
  • Giacomo Cimicchi,
  • Gaia Ottonello,
  • Rossano Ghedin,
  • Francesco Giacalone,
  • Tiziana Bove,
  • Francesco Meroi,
  • Sara Scapol,
  • Laura Pistidda,
  • Angela Muretti,
  • Savino Spadaro,
  • Gaetano Scaramuzzo,
  • Gioconda Ferraro,
  • Giuseppe Gagliardi,
  • Giovanni Sabbatini,
  • Angelo Pezzi,
  • Gabriele Sales,
  • Giorgia Montrucchio,
  • Andrea Carsetti,
  • Federico Longhini,
  • Maria Vargas,
  • Plinio Calligaro,
  • Ilaria Mariani,
  • Vanessa Zambelli,
  • Beatrice Noè,
  • Filippo Serra

DOI
https://doi.org/10.1097/CCE.0000000000001039
Journal volume & issue
Vol. 6, no. 2
p. e1039

Abstract

Read online

OBJECTIVES:. In patients with COVID-19 respiratory failure, controlled mechanical ventilation (CMV) is often necessary during the acute phases of the disease. Weaning from CMV to pressure support ventilation (PSV) is a key objective when the patient’s respiratory functions improve. Limited evidence exists regarding the factors predicting a successful transition to PSV and its impact on patient outcomes. DESIGN:. Retrospective observational cohort study. SETTING:. Twenty-four Italian ICUs from February 2020 to May 2020. PATIENTS:. Mechanically ventilated ICU patients with COVID-19-induced respiratory failure. INTERVENTION:. The transition period from CMV to PSV was evaluated. We defined it as “failure of assisted breathing” if the patient returned to CMV within the first 72 hours. MEASUREMENTS AND MAIN RESULTS:. Of 1260 ICU patients screened, 514 were included. Three hundred fifty-seven patients successfully made the transition to PSV, while 157 failed. Pao2/Fio2 ratio before the transition emerged as an independent predictor of a successful shift (odds ratio 1.00; 95% CI, 0.99–1.00; p = 0.003). Patients in the success group displayed a better trend in Pao2/Fio2, Paco2, plateau and peak pressure, and pH level. Subjects in the failure group exhibited higher ICU mortality (hazard ratio 2.08; 95% CI, 1.42–3.06; p < 0.001), an extended ICU length of stay (successful vs. failure 21 ± 14 vs. 27 ± 17 d; p < 0.001) and a longer duration of mechanical ventilation (19 ± 18 vs. 24 ± 17 d, p = 0.04). CONCLUSIONS:. Our study emphasizes that the Pao2/Fio2 ratio was the sole independent factor associated with a failed transition from CMV to PSV. The unsuccessful transition was associated with worse outcomes.