Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs
Abstract Background A large proportion of patients with coronavirus disease 2019 (COVID-19) develop severe respiratory failure requiring admission to the intensive care unit (ICU) and about 80% of them need mechanical ventilation (MV). These patients show great complexity due to multiple organ invol...
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2020-10-01
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Series: | Journal of Intensive Care |
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Online Access: | http://link.springer.com/article/10.1186/s40560-020-00499-4 |
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record_format |
Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lorenzo Gamberini Tommaso Tonetti Savino Spadaro Gianluca Zani Carlo Alberto Mazzoli Chiara Capozzi Emanuela Giampalma Maria Letizia Bacchi Reggiani Elisabetta Bertellini Andrea Castelli Irene Cavalli Davide Colombo Federico Crimaldi Federica Damiani Alberto Fogagnolo Maurizio Fusari Emiliano Gamberini Giovanni Gordini Cristiana Laici Maria Concetta Lanza Mirco Leo Andrea Marudi Giuseppe Nardi Irene Ottaviani Raffaella Papa Antonella Potalivo Emanuele Russo Stefania Taddei Carlo Alberto Volta V. Marco Ranieri the ICU-RER COVID-19 Collaboration |
spellingShingle |
Lorenzo Gamberini Tommaso Tonetti Savino Spadaro Gianluca Zani Carlo Alberto Mazzoli Chiara Capozzi Emanuela Giampalma Maria Letizia Bacchi Reggiani Elisabetta Bertellini Andrea Castelli Irene Cavalli Davide Colombo Federico Crimaldi Federica Damiani Alberto Fogagnolo Maurizio Fusari Emiliano Gamberini Giovanni Gordini Cristiana Laici Maria Concetta Lanza Mirco Leo Andrea Marudi Giuseppe Nardi Irene Ottaviani Raffaella Papa Antonella Potalivo Emanuele Russo Stefania Taddei Carlo Alberto Volta V. Marco Ranieri the ICU-RER COVID-19 Collaboration Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs Journal of Intensive Care Coronavirus disease 2019 Intensive care Mechanical ventilation Outcomes, mortality Respiration, artificial ARDS |
author_facet |
Lorenzo Gamberini Tommaso Tonetti Savino Spadaro Gianluca Zani Carlo Alberto Mazzoli Chiara Capozzi Emanuela Giampalma Maria Letizia Bacchi Reggiani Elisabetta Bertellini Andrea Castelli Irene Cavalli Davide Colombo Federico Crimaldi Federica Damiani Alberto Fogagnolo Maurizio Fusari Emiliano Gamberini Giovanni Gordini Cristiana Laici Maria Concetta Lanza Mirco Leo Andrea Marudi Giuseppe Nardi Irene Ottaviani Raffaella Papa Antonella Potalivo Emanuele Russo Stefania Taddei Carlo Alberto Volta V. Marco Ranieri the ICU-RER COVID-19 Collaboration |
author_sort |
Lorenzo Gamberini |
title |
Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs |
title_short |
Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs |
title_full |
Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs |
title_fullStr |
Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs |
title_full_unstemmed |
Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs |
title_sort |
factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen italian icus |
publisher |
BMC |
series |
Journal of Intensive Care |
issn |
2052-0492 |
publishDate |
2020-10-01 |
description |
Abstract Background A large proportion of patients with coronavirus disease 2019 (COVID-19) develop severe respiratory failure requiring admission to the intensive care unit (ICU) and about 80% of them need mechanical ventilation (MV). These patients show great complexity due to multiple organ involvement and a dynamic evolution over time; moreover, few information is available about the risk factors that may contribute to increase the time course of mechanical ventilation. The primary objective of this study is to investigate the risk factors associated with the inability to liberate COVID-19 patients from mechanical ventilation. Due to the complex evolution of the disease, we analyzed both pulmonary variables and occurrence of non-pulmonary complications during mechanical ventilation. The secondary objective of this study was the evaluation of risk factors for ICU mortality. Methods This multicenter prospective observational study enrolled 391 patients from fifteen COVID-19 dedicated Italian ICUs which underwent invasive mechanical ventilation for COVID-19 pneumonia. Clinical and laboratory data, ventilator parameters, occurrence of organ dysfunction, and outcome were recorded. The primary outcome measure was 28 days ventilator-free days and the liberation from MV at 28 days was studied by performing a competing risks regression model on data, according to the method of Fine and Gray; the event death was considered as a competing risk. Results Liberation from mechanical ventilation was achieved in 53.2% of the patients (208/391). Competing risks analysis, considering death as a competing event, demonstrated a decreased sub-hazard ratio for liberation from mechanical ventilation (MV) with increasing age and SOFA score at ICU admission, low values of PaO2/FiO2 ratio during the first 5 days of MV, respiratory system compliance (CRS) lower than 40 mL/cmH2O during the first 5 days of MV, need for renal replacement therapy (RRT), late-onset ventilator-associated pneumonia (VAP), and cardiovascular complications. ICU mortality during the observation period was 36.1% (141/391). Similar results were obtained by the multivariate logistic regression analysis using mortality as a dependent variable. Conclusions Age, SOFA score at ICU admission, CRS, PaO2/FiO2, renal and cardiovascular complications, and late-onset VAP were all independent risk factors for prolonged mechanical ventilation in patients with COVID-19. Trial registration NCT04411459 |
topic |
Coronavirus disease 2019 Intensive care Mechanical ventilation Outcomes, mortality Respiration, artificial ARDS |
url |
http://link.springer.com/article/10.1186/s40560-020-00499-4 |
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doaj-a1cbbf12909f4f5e90f701510fcb6bef2020-11-25T03:51:57ZengBMCJournal of Intensive Care2052-04922020-10-018111210.1186/s40560-020-00499-4Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUsLorenzo Gamberini0Tommaso Tonetti1Savino Spadaro2Gianluca Zani3Carlo Alberto Mazzoli4Chiara Capozzi5Emanuela Giampalma6Maria Letizia Bacchi Reggiani7Elisabetta Bertellini8Andrea Castelli9Irene Cavalli10Davide Colombo11Federico Crimaldi12Federica Damiani13Alberto Fogagnolo14Maurizio Fusari15Emiliano Gamberini16Giovanni Gordini17Cristiana Laici18Maria Concetta Lanza19Mirco Leo20Andrea Marudi21Giuseppe Nardi22Irene Ottaviani23Raffaella Papa24Antonella Potalivo25Emanuele Russo26Stefania Taddei27Carlo Alberto Volta28V. Marco Ranieri29the ICU-RER COVID-19 CollaborationDepartment of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto PizzardiAlma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant’Orsola, Università di BolognaDepartment of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care University of Ferrara, Azienda Ospedaliero-Universitaria S. AnnaDepartment of Anesthesia and Intensive Care, Santa Maria delle Croci HospitalDepartment of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto PizzardiCardio-Anesthesiology Unit, Cardio-Thoracic-Vascular Department, S.Orsola Hospital, University of BolognaRadiology Department, M.Bufalini HospitalAlma Mater University, Department of Clinical, Integrated and Experimental Medicine (DIMES), Statistical Service, S. Orsola-Malpighi Hospital BolognaDepartment of Anaesthesiology, University Hospital of ModenaCardio-Anesthesiology Unit, Cardio-Thoracic-Vascular Department, S.Orsola Hospital, University of BolognaAlma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant’Orsola, Università di BolognaAnaesthesia and Intensive Care Department, SS. Trinità Hospital, ASLAnaesthesia and Intensive Care Residency Program – Translational Medicine Department, Eastern Piedmont UniversityDepartment of Anaesthesia, Intensive Care and Pain Therapy – Imola HospitalDepartment of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care University of Ferrara, Azienda Ospedaliero-Universitaria S. AnnaDepartment of Anesthesia and Intensive Care, Santa Maria delle Croci HospitalAnaesthesia and Intensive Care Unit, M. Bufalini HospitalDepartment of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto PizzardiDivision of Anesthesiology, Hospital S. Orsola Malpighi, Alma Mater Studiorum University of BolognaDepartment of Anesthesia and Intensive Care, G.B. Morgagni-Pierantoni HospitalDepartment of Anaesthesia and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare ArrigoDepartment of Anaesthesiology, University Hospital of ModenaDepartment of Anaesthesia and Intensive Care, Infermi HospitalDepartment of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care University of Ferrara, Azienda Ospedaliero-Universitaria S. AnnaAnaesthesia and Intensive Care Unit, Santa Maria Annunziata HospitalDepartment of Anaesthesia and Intensive Care, Infermi HospitalAnaesthesia and Intensive Care Unit, M. Bufalini HospitalAnaesthesia and Intensive Care Unit, Bentivoglio HospitalDepartment of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care University of Ferrara, Azienda Ospedaliero-Universitaria S. AnnaAlma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant’Orsola, Università di BolognaAbstract Background A large proportion of patients with coronavirus disease 2019 (COVID-19) develop severe respiratory failure requiring admission to the intensive care unit (ICU) and about 80% of them need mechanical ventilation (MV). These patients show great complexity due to multiple organ involvement and a dynamic evolution over time; moreover, few information is available about the risk factors that may contribute to increase the time course of mechanical ventilation. The primary objective of this study is to investigate the risk factors associated with the inability to liberate COVID-19 patients from mechanical ventilation. Due to the complex evolution of the disease, we analyzed both pulmonary variables and occurrence of non-pulmonary complications during mechanical ventilation. The secondary objective of this study was the evaluation of risk factors for ICU mortality. Methods This multicenter prospective observational study enrolled 391 patients from fifteen COVID-19 dedicated Italian ICUs which underwent invasive mechanical ventilation for COVID-19 pneumonia. Clinical and laboratory data, ventilator parameters, occurrence of organ dysfunction, and outcome were recorded. The primary outcome measure was 28 days ventilator-free days and the liberation from MV at 28 days was studied by performing a competing risks regression model on data, according to the method of Fine and Gray; the event death was considered as a competing risk. Results Liberation from mechanical ventilation was achieved in 53.2% of the patients (208/391). Competing risks analysis, considering death as a competing event, demonstrated a decreased sub-hazard ratio for liberation from mechanical ventilation (MV) with increasing age and SOFA score at ICU admission, low values of PaO2/FiO2 ratio during the first 5 days of MV, respiratory system compliance (CRS) lower than 40 mL/cmH2O during the first 5 days of MV, need for renal replacement therapy (RRT), late-onset ventilator-associated pneumonia (VAP), and cardiovascular complications. ICU mortality during the observation period was 36.1% (141/391). Similar results were obtained by the multivariate logistic regression analysis using mortality as a dependent variable. Conclusions Age, SOFA score at ICU admission, CRS, PaO2/FiO2, renal and cardiovascular complications, and late-onset VAP were all independent risk factors for prolonged mechanical ventilation in patients with COVID-19. Trial registration NCT04411459http://link.springer.com/article/10.1186/s40560-020-00499-4Coronavirus disease 2019Intensive careMechanical ventilationOutcomes, mortalityRespiration, artificialARDS |