Association of ventilator type with hospital mortality in critically ill patients with SARS-CoV2 infection: a prospective study

 

by Alexis Ferré, Fabien Marquion, Marc Delord, Antoine Gros, Guillaume Lacave, Virginie Laurent, Sybille Merceron, Marine Paul, Christelle Simon, Gilles Troché, Clément Charbonnel, Stéphanie Marque-Juillet, Fabrice Bruneel and Stéphane Legriel 

 

Annals of Intensive Care volume 12, Article number: 10 (2022) 

 

Background

To evaluate the association between ventilator type and hospital mortality in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (SARS-CoV2 infection), a single-center prospective observational study in France.

Results

We prospectively included consecutive adults admitted to the intensive care unit (ICU) of a university-affiliated tertiary hospital for ARDS related to proven COVID-19, between March 2020 and July 2021. All patients were intubated. We compared two patient groups defined by whether an ICU ventilator or a less sophisticated ventilator such as a sophisticated turbine-based transport ventilator was used. Kaplan–Meier survival curves were plotted. Cox multivariate regression was performed to identify associations between patient characteristics and hospital mortality. We included 189 patients (140 [74.1%] men) with a median age of 65 years [IQR, 55–73], of whom 61 (32.3%) died before hospital discharge. By multivariate analysis, factors associated with in-hospital mortality were age ≥ 70 years (HR, 2.11; 95% CI, 1.24–3.59; P = 0.006), immunodeficiency (HR, 2.43; 95% CI, 1.16–5.09; P = 0.02) and serum creatinine ≥ 100 µmol/L (HR, 3.01; 95% CI, 1.77–5.10; P < 0.001) but not ventilator type. As compared to conventional ICU (equipped with ICU and anesthesiology ventilators), management in transient ICU (equipped with non-ICU turbine-based ventilators) was associated neither with a longer duration of invasive mechanical ventilation (18 [IQR, 11–32] vs. 21 [13–37] days, respectively; P = 0.39) nor with a longer ICU stay (24 [IQR, 14–40] vs. 27 [15–44] days, respectively; P = 0.44).

Conclusions

In ventilated patients with ARDS due to COVID-19, management in transient ICU equipped with non-ICU sophisticated turbine-based ventilators was not associated with worse outcomes compared to standard ICU, equipped with ICU ventilators. Although our study design is not powered to demonstrate any difference in outcome, our results after adjustment do not suggest any signal of harm when using these transport type ventilators as an alternative to ICU ventilators during COVID-19 surge.

Observational study of patient-ventilator asynchrony and relationship to sedation level.

Observational study of patient-ventilator asynchrony and relationship to sedation level.
de Wit M, Pedram S, Best AM, Epstein SK.
J Crit Care. 2009 Mar;24(1):74-80. Epub 2009 Jan 17.PMID: 19272542 [PubMed - in process]Related Articles


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Tanios MA, de Wit M, Epstein SK, Devlin JW.
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Weaning from ventilatory support

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Epstein SK.
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Understanding ventilator waveforms-and how to use them in patient care.

NURSING CRITICAL CARE
VOL 4; NUMB 1; 2009
ISSN 1558-447X

pp. 43-55
Understanding ventilator waveforms-and how to use them in patient care.
Lian, J.X.

Ventilator-associated tracheobronchitis (VAT): questions, answers, and a new paradigm ?

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Author(s): Donald E Craven
ISSUE: 2008 ; VOL 12 (2008-01-03)
Journal Title: Critical Care From BioMed Central [PDF] [Abstract]

From Free Medical Journals . com (/1997 - /Embargo: 2 years)

From UK PubMed Central (/1997 - /2008)
Page: 157
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Critical Care articles - 10 May 2008

The latest articles from Critical Care, published between 11-Apr-2008 and 10-May-2008
For research articles that have only just been published you will see a 'provisional PDF' corresponding to the accepted manuscript.

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Review Bench-to-bedside review: The evaluation of complex interventions in critical care Delaney A, Angus D, Bellomo R, Cameron P, Cooper D, Finfer S, Harrison D, Huang D, Myburgh J, Peake S, Reade M, Webb S, Yealy D, Critical Care, 2008 12:210 ( 14 April 2008 )
[Abstract][Full text] [PDF]

Commentary Diagnosing sepsis: does the microbiology matter? Cohen JCritical Care, 2008 12:145 ( 6 May 2008 )[Abstract][Full text] [PDF]

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Critical Care, 2008 12:142 ( 29 April 2008 )[Abstract][Full text] [PDF]

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Research Severe hyperlactatemia with normal base excess: a quantitative analysis using conventional and Stewart approaches Tuhay G, Pein M, Masevicius F, Olmos Kutscherauer D, Dubin ACritical Care, 2008 12:R66 ( 8 May 2008 ) [Abstract] [Provisional PDF]

Research Adrenal insufficiency in prolonged critical illness
Wu J, Hsu S, Ku S, Ho C, Yu C, Yang PCritical Care, 2008 12:R65 ( 8 May 2008 )
[Abstract] [Provisional PDF]

Research A phase 1 trial of nebulised heparin in acute lung injury Dixon B, Santamaria J, Campbell DCritical Care, 2008 12:R64 ( 6 May 2008 ) [Abstract] [Provisional PDF] [PubMed]

Research Cerebral perfusion in sepsis-associated delirium
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Research Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized controlled multicenter study
Nseir S, Favory R, Jozefowicz E, Decamps F, Dewavrin F, Brunin G, Di Pompeo C, Mathieu D, Durocher ACritical Care, 2008 12:R62 ( 2 May 2008 )[Abstract] [Provisional PDF] [PubMed]

Research Improved outcomes from the administration of progesterone for patients with acute severe traumatic brain injury: a randomized controlled trial
Xiao G, Wei J, Yan W, Wang W, Lu ZCritical Care, 2008 12:R61 ( 30 April 2008 )[Abstract][Full text] [PDF] [PubMed]

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Research Eosinopenia is a reliable marker of sepsis on admission in medical intensive care units
Abidi K, Khoudri I, Belayachi J, Madani N, Zekraoui A, Zeggwagh A, Abouqal RCritical Care, 2008 12:R59 ( 24 April 2008 )[Abstract] [Provisional PDF] [PubMed]

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Research Survival time in severe hemorrhagic shock after perioperiative hemodilution scenario with polyethylene glycol conjugated human serum albumin is longer than with HES 130/0.4: a microvascular perspective Martini J, Cabrales P, K. A, Acharya S, Intaglietta M, Tsai ACritical Care, 2008 12:R54 ( 18 April 2008 )[Abstract] [Provisional PDF] [PubMed]

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Research Respiratory effects of different recruitment maneuvers in acute respiratory distress syndrome Constantin J, Jaber S, Futier E, Cayot-Constantin S, Verny-Pic M, Jung B, Bailly A, Guerin R, Bazin JCritical Care, 2008 12:R50 ( 16 April 2008 )[Abstract][Full text] [PDF] [PubMed]

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Ventilator articles:

Effect of Clarithromycin in Patients with Sepsis and Ventilator - Associated Pneumonia
Author(s): Giamarellos - Bourboulis , E . J . ; Pechere , J . - C . ; Routsi , C . ; Plachouras , D . ; Kollias , S . ; Raftogiannis , M . ; Zervakis , D . ; Baziaka , F . ; Koronaios , A . ; Antonopoulou , A .
ISSUE: 2008 ; VOL 46 ; PART 8
Journal Title: Clinical Infectious Diseases From Free Medical Journals . com (/1997 - /Embargo: 1 year)

From Proquest NHS (12/2004 - 07/2006)
Page: 1157-1164
ISSN: Print: 1058-4838
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Efficacy and safety of intravenous infusion of doripenem versus imipenem in ventilator - associated pneumonia : A multicenter , randomized study
Author(s): Chastre , J . ; Wunderink , R . ; Prokocimer , P . ; Lee , M . ; Kaniga , K . ; Friedland , I .
ISSUE: 2008 ; VOL 36 ; PART 4
Journal Title: Critical Care Medicine From Ovid ( Journals @ Ovid ) via Athens (01/1995 - /) Customer Notes: 1997 v25/1 - Print Location: Macclesfield
Page: 1089-1096
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On the Other Side of Patient Care : Two respiratory therapists tell their stories of what it is like to be on the receiving end of ventilatory care
ISSUE: 2008 ; VOL 32 ; PART 4
Journal Title: AARC Times ( Formerly : AAR Times ) AARC Times ( Formerly : AAR Times )
Page: 44-51
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Do new anesthesia ventilators deliver small tidal volumes accurately during volume-controlled ventilation?

Anesth Analg. 2008 May;106(5):1392-400, table of contents.
PubMed - indexed for MEDLINE]

Click on author to view: Bachiller PR, McDonough JM, Feldman JM.
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Health is yearning--experiences of being conscious during ventilator treatment in a critical care unit.

Request this article through
Health Sciences Library Macclesfield District General Hospital (Inter Library Loan)

Source Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses, {Intensive-Crit-Care- Nurs}, Feb 2008 (epub: 03 Aug 2007),
vol. 24, no. 1, p. 41-50,
Author(s) Karlsson-Veronika, Forsberg-Anna.

Abstract
The aim of this study was to investigate experiences of being conscious during ventilator treatment in the ICU from a patient perspective. Hermeneutic, phenomenological methods were used. Eight patients who had received ventilator treatment were interviewed. The time on a ventilator varied from 1 day to several months. Some patients had been more heavily sedated during the acute phase while some were only lightly sedated and others had no sedation at all. The motor activity assessment scale was used to rate the sedation level. The patients had been sufficiently conscious to communicate with the help of the alphabet board, by means of facial expression or by nodding or shaking their head. The results show that the experience of care by patients who were conscious during ventilator treatment was described under the headings of: memories, mastering the situation and individual consequences. Health in the ICU is associated with yearning. The patient undergoes different stages of yearning as part of his or her recovery process. The patient who is conscious during ventilator treatment views him/herself and his/her worth on the basis of the attitude and behaviour of the caregivers, where the value of caring consists of the holistic confirmation of individual suffering.

Poster presentations from Critical Care

Interdisciplinary ethics consultation on the surgical ICU: indication 'on a gut level'?
Chromik A, Wemhöner T, Sülberg D, Laubenthal H, Mittelkötter U, Uhl WCritical Care 2008, 12(Suppl 2):P523 (13 March 2008)

Intensive care not confined to the bedspace: successfully implemented ventilation and monitoring solution for ICU intrahospital transport that is offering improvements in patient care
Williams DCritical Care 2008, 12(Suppl 2):P532 (13 March 2008) [Full text] [PDF]


Coagulation in hospitalized community-acquired pneumonia: disturbances in even the least ill
Reade MC, Milbrandt EB, Yende S, Shook SL, Kong L, Angus DC, Kellum JA, for the GenIMS Investigators Critical Care 2008, 12(Suppl 2):P202 (13 March 2008) [Full text] [PDF]


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Effect of an oral care protocol in preventing ventilator-associated pneumonia in ICU patients
Yao L, Chang C, Wang C, Chen CCritical Care 2008, 12(Suppl 2):P48 (13 March 2008) [Full text] [PDF]


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Prebiotic, probiotic and synbiotic usage and gastrointestinal and trachea colonization in mechanically ventilated patientsShinotsuka CR, Alexandre MR, David CMCritical Care 2008, 12(Suppl 2):P52 (13 March 2008) [Full text] [PDF]


A potential role for the chest X-ray in the transmission of resistant bacteria in the ICU Levin PD, Shatz O, Moriah D, Sviri S, Or-Barbash A, Sprung CL, Block CCritical Care 2008, 12(Suppl 2):P10 (13 March 2008) [Full text] [PDF]


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Procalcitonin to guide length of antibiotic therapy in surgical intensive care patients Schroeder S, Hochreiter M, Koehler T, Von Spiegel TCritical Care 2008, 12(Suppl 2):P182 (13 March 2008)[Full text] [PDF]


Procalcitonin in elective colorectal surgery and its predictive value for an early discharge of fast-track patients Chromik A, Uhl W, Thiede A, Reith H, Mittelkötter UCritical Care 2008, 12(Suppl 2):P185 (13 March 2008) [Full text] [PDF]

Transforming growth factor beta 1 gene transcription in infection and severe sepsis displays distinguishing characteristics White M, O'Dwyer MJ, Grealy R, Stordeur P, O'Connell B, Kelleher DK, McManus R, Ryan TCritical Care 2008, 12(Suppl 2):P197 (13 March 2008)
[Full text] [PDF]

Comparison of sedation with dexmedetomidine versus lorazepam in septic ICU patients Pandharipande P, Girard TD, Sanders RD, Thompson JL, Maze M, Ely EWCritical Care 2008, 12(Suppl 2):P275 (13 March 2008) [Full text] [PDF]

Ventilator articles

Systematic surveillance cultures as a toolto predict involvement of multidrug antibiotic resistant bacteria in ventilator - associated pneumonia
Author(s): Depuydt , P . ; Benoit , D . ; Vogelaers , D . ; Decruyenaere , J . ; Vandijck , D . ; Claeys , G . ; Verschraegen , G . ; Blot , S .
ISSUE: 2008 ; VOL 34 ; PART 4 (2008/04/01)
Journal Title: Intensive Care Medicine From Proquest NHS (01/2002 - 03/2007)
Page: 675-682
ISSN:
Print: 0342-4642
E-Version: 1432-1238
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Hitting new barriers in ventilator - induced lung injury
Author(s): Kuebler , Wolfgang
ISSUE: 2008 ; VOL 34 ; PART 4 (2008/04/01)
Journal Title: Intensive Care Medicine From Proquest NHS (01/2002 - 03/2007)
Page: 592-594
ISSN:
Print: 0342-4642
E-Version: 1432-1238
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The clinical and research applications of aerobic capacity and ventilatory efficiency in heart failure : an evidence - based review
Author(s): Ross Arena ; Jonathan Myers ; Marco Guazzi
ISSUE: 2008 ; VOL 13 ; PART 2 (2008/06/01)
Journal Title: Heart Failure Reviews From Proquest NHS (07/1999 - 03/2007)
Page: 245 - 269
ISSN:
Print: 1382-4147
E-Version: 1573-7322
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Sedation of ventilated patients in intensive care units: relatives' experiences.

Sedation of ventilated patients in intensive care units: relatives' experiences.
Dreyer-Anne, Nortvedt-Per.
Journal of advanced nursing, {J-Adv-Nurs}, Mar 2008, vol. 61, no. 5, p. 549-56, ISSN: 1365-2648.

Paper copy available at
Health Sciences Library Macclesfield District General Hospital
18261064 Medline 20080306.

Abstract
AIM: This paper is a report of a study undertaken to explore the experiences of being relatives of ventilated and sedated patients in intensive care units.

BACKGROUND: In the last few years, issues about medically-induced sleep as part of intensive care unit treatment have focused on the appropriate level of medication. There are no studies of the impact of relatives on assessment of sedation levels, but studies of family participation in intensive care units show that relatives see their role as more important for the patient than nurses do.

METHOD: An explorative, descriptive design was adopted. In-depth interviews were conducted with eight relatives of patients in 2003. The research question was: How do relatives experience having a close family member in a state of serious illness, being treated on a ventilator, and receiving medically induced sedation and pain relief? Kvale's hermeneutical interpretation principles were used for data analysis.

RESULTS: Relatives interviewed seemed to go through various phases that were specifically connected to the actual situation in the intensive care unit. The main characteristic of these phases was a pattern in which participants gradually became active caregivers for the patient. Relatives wanted to be included in discussions about treatment.

CONCLUSION: Relatives want to be included as caregivers when patients are under sedation in an intensive care unit. Relatives who know the patient can help evaluate the use of sedation and pain management to assist the nurses in giving the best care and the appropriate level of sedation for a patient.

Ventilator articles

Randomized trial of combination versus monotherapy for the empiric treatment of suspected ventilator - associated pneumonia
Author(s): Heyland , D . K . ; Dodek , P . ; Muscedere , J . ; Day , A . ; Cook , D . ; Canadian Critical Care Trials Group
ISSUE: 2008 ; VOL 36 ; PART 3
Journal Title: Critical Care Medicine From Ovid ( Journals @ Ovid ) via Athens (01/1995 - /) Customer Notes: 1997 v25/1 - Print Location: Macclesfield
Page: 737-744
ISSN: Print: 0090-3493
E-Version: 1530-0293
BL Shelfmark: 3487.451000
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How can earlier antibiotic efficacy be provided for ventilator - associated pneumonia without promoting bacterial resistance ? Is initial monotherapy or a combination of antibiotics the right answer ?
Author(s): Papazian , L .
ISSUE: 2008 ; VOL 36 ; PART 3
Journal Title: Critical Care Medicine From Ovid ( Journals @ Ovid ) via Athens (01/1995 - /) Customer Notes: 1997 v25/1 - Print Location: Macclesfield
Page: 994-995
ISSN: Print: 0090-3493
E-Version: 1530-0293
BL Shelfmark: 3487.451000
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Acute hospitals targeted for patient safety campaign

The Welsh Critical Care Improvement Programme uses the ventilator-acquired pneumonia and central line bundles in every adult intensive care unit in the ...

OnMedica - London,UK

Ventilator - Associated Pneumonia as a Quality Indicator for Patient Safety ?

Author(s): Uckay , I . ; Ahmed , Q . A . ; Sax , H . ; Pittet , D .
ISSUE: 2008 ; VOL 46 ; PART 4
Journal Title:Access
Clinical Infectious Diseases From Free Medical Journals . com (/1997 - /Embargo: 1 year)

From Proquest NHS (12/2004 - 07/2006)
Page: 557-563
ISSN: Print: 1058-4838
E-Version: 1537-6591
BL Shelfmark: 3286.293860
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