Critical Care Explorations (Jan 2021)

Association Between Early Invasive Mechanical Ventilation and Day-60 Mortality in Acute Hypoxemic Respiratory Failure Related to Coronavirus Disease-2019 Pneumonia

  • Claire Dupuis, MD, PhD,
  • Lila Bouadma, MD, PhD,
  • Etienne de Montmollin, MD, PhD,
  • Dany Goldgran-Toledano, MD,
  • Carole Schwebel, MD, PhD,
  • Jean Reignier, MD, PhD,
  • Mathilde Neuville, MD,
  • Moreno Ursino, PhD,
  • Shidasp Siami, MD,
  • Stéphane Ruckly, MSc,
  • Corinne Alberti, MD, PhD,
  • Bruno Mourvillier, MD, PhD,
  • Sébastien Bailly, PharmD, PhD,
  • Kévin Grapin, MD,
  • Virginie Laurent, MD,
  • Niccolo Buetti, MD, PhD,
  • Marc Gainnier, MD,
  • Bertrand Souweine, MD, PhD,
  • Jean-François Timsit, MD, PhD,
  • for the OUTCOMEREA Study Group,
  • Jean-François Timsit,
  • Elie Azoulay,
  • Maïté Garrouste-Orgeas,
  • Jean-Ralph Zahar,
  • Bruno Mourvillier,
  • Christophe Clec’h,
  • Corinne Alberti,
  • Stephane Ruckly,
  • Sébastien Bailly,
  • Aurélien Vannieuwenhuyze,
  • Christophe Adrie,
  • Carole Agasse,
  • Bernard Allaouchiche,
  • Olivier Andremont,
  • Pascal Andreu,
  • Laurent Argaud,
  • Claire Ara-Somohano,
  • Elie Azoulay,
  • Francois Barbier,
  • Déborah Boyer,
  • Jean-Pierre Bedos,
  • Thomas Baudry,
  • Jérome Bedel,
  • Julien Bohé,
  • Lila Bouadma,
  • Jeremy Bourenne,
  • Noel Brule,
  • Cédric Brétonnière,
  • Frank Chemouni,
  • Christine Cheval,
  • Julien Carvelli,
  • Elisabeth Coupez,
  • Martin Cour,
  • Claire Dupuis,
  • Etienne de Montmollin,
  • Loa Dopeux,
  • Anne-Sylvie Dumenil,
  • Jean-Marc Forel,
  • Marc Gainnier,
  • Charlotte Garret,
  • Dany Goldgran-Tonedano,
  • Steven Grangé,
  • Antoine Gros,
  • Hédia Hammed,
  • Akim Haouache,
  • Romain Hernu,
  • Tarik Hissem,
  • Vivien Hong Tuan Ha,
  • Sébastien Jochmans,
  • Jean-Baptiste Joffredo,
  • Hatem Kallel,
  • Guillaume Lacave,
  • Virgine Laurent,
  • Alexandre Lautrette,
  • Clément Le bihan,
  • Eric Magalhaes,
  • Virgine Lemiale,
  • Guillaume Marcotte,
  • Jordane Lebut,
  • Maxime Lugosi,
  • Sibylle Merceron,
  • Benoît Misset,
  • Mathild Neuville,
  • Laurent Nicolet,
  • Johanna Oziel,
  • Laurent Papazian,
  • Juliette Patrier,
  • Benjamin Planquette,
  • Aguila Radjou,
  • Marie Simon,
  • Romain Sonneville,
  • Jean Reignier,
  • Bertrand Souweine,
  • Carole Schwebel,
  • Shidasp Siami,
  • Romain Sonneville,
  • Nicolas Terzi,
  • Gilles Troché,
  • Marie Thuong,
  • Guillaume Thierry,
  • Marion Venot,
  • Sondes Yaacoubi,
  • Olivier Zambon,
  • Julien Fournier,
  • Stéphanie Bagur,
  • Mireille Adda,
  • Vanessa Vindrieux,
  • Sylvie de la Salle,
  • Pauline Enguerrand,
  • Vincent Gobert,
  • Stéphane Guessens,
  • Helene Merle,
  • Nadira Kaddour,
  • Boris Berthe,
  • Samir Bekkhouche,
  • Kaouttar Mellouk,
  • Mélaine Lebrazic,
  • Carole Ouisse,
  • Diane Maugars,
  • Christelle Aparicio,
  • Igor Theodose,
  • Manal Nouacer,
  • Veronique Deiler,
  • Fariza Lamara,
  • Myriam Moussa,
  • Atika Mouaci,
  • Nassima Viguier

DOI
https://doi.org/10.1097/CCE.0000000000000329
Journal volume & issue
Vol. 3, no. 1
p. e0329

Abstract

Read online

Objectives:. About 5% of patients with coronavirus disease-2019 are admitted to the ICU for acute hypoxemic respiratory failure. Opinions differ on whether invasive mechanical ventilation should be used as first-line therapy over noninvasive oxygen support. The aim of the study was to assess the effect of early invasive mechanical ventilation in coronavirus disease-2019 with acute hypoxemic respiratory failure on day-60 mortality. Design:. Multicenter prospective French observational study. Setting:. Eleven ICUs of the French OutcomeRea network. Patients:. Coronavirus disease-2019 patients with acute hypoxemic respiratory failure (Pao2/Fio2 ≤ 300 mm Hg), without shock or neurologic failure on ICU admission, and not referred from another ICU or intermediate care unit were included. Intervention:. We compared day-60 mortality in patients who were on invasive mechanical ventilation within the first 2 calendar days of the ICU stay (early invasive mechanical ventilation group) and those who were not (nonearly invasive mechanical ventilation group). We used a Cox proportional-hazard model weighted by inverse probability of early invasive mechanical ventilation to determine the risk of death at day 60. Measurement and Main Results:. The 245 patients included had a median (interquartile range) age of 61 years (52–69 yr), a Simplified Acute Physiology Score II score of 34 mm Hg (26–44 mm Hg), and a Pao2/Fio2 of 121 mm Hg (90–174 mm Hg). The rates of ICU-acquired pneumonia, bacteremia, and the ICU length of stay were significantly higher in the early (n = 117 [48%]) than in the nonearly invasive mechanical ventilation group (n = 128 [52%]), p < 0.01. Day-60 mortality was 42.7% and 21.9% in the early and nonearly invasive mechanical ventilation groups, respectively. The weighted model showed that early invasive mechanical ventilation increased the risk for day-60 mortality (weighted hazard ratio =1.74; 95% CI, 1.07–2.83, p=0.03). Conclusions:. In ICU patients admitted with coronavirus disease-2019-induced acute hypoxemic respiratory failure, early invasive mechanical ventilation was associated with an increased risk of day-60 mortality. This result needs to be confirmed.