by Kamil Polok,
Jakub Fronczek, Bertrand Guidet, Antonio Artigas, 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…
Annals of
Intensive Care volume 13,
Article number: 82 (2023)
Background
Non-invasive ventilation (NIV) has been commonly used to
treat acute respiratory failure due to COVID-19. In this study we aimed to
compare outcomes of older critically ill patients treated with NIV before and
during the COVID-19 pandemic.
Methods
We analysed a merged cohort of older adults admitted to
intensive care units (ICUs) due to respiratory failure. Patients were enrolled
into one of two prospective observational studies: before COVID-19 (VIP2—2018
to 2019) and admitted due to COVID-19 (COVIP—March 2020 to January 2023). The
outcomes included: 30-day mortality, intubation rate and NIV failure (death or
intubation within 30 days).
Results
The final cohort included 1986 patients (1292 from VIP2, 694
from COVIP) with a median age of 83 years. NIV was used as a primary mode of
respiratory support in 697 participants (35.1%). ICU admission due to COVID-19
was associated with an increased 30-day mortality (65.5% vs. 36.5%, HR 2.18,
95% CI 1.71 to 2.77), more frequent intubation (36.9% vs. 17.5%, OR 2.63, 95%
CI 1.74 to 3.99) and NIV failure (76.2% vs. 45.3%, OR 4.21, 95% CI 2.84 to
6.34) compared to non-COVID causes of respiratory failure. Sensitivity analysis
after exclusion of patients in whom life supporting treatment limitation was
introduced during primary NIV confirmed higher 30-day mortality in patients
with COVID-19 (52.5% vs. 23.4%, HR 2.64, 95% CI 1.83 to 3.80).
Conclusion
The outcomes of patients aged ≥80 years treated with NIV
during COVID-19 pandemic were worse compared then those treated with NIV in the
pre-pandemic era.
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