SEARCHCOHORTcritical care, pulmonology

cohort·critical care, pulmonology, geriatrics, infectious disease, observational study·PMC10497468

Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic

Annals of Intensive Care · 23 authors, 25 centres

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TL;DR

This prospective observational cohort study of 1986 patients aged ≥80 years compared outcomes of non-invasive ventilation (NIV) for respiratory failure in European ICUs before versus during the COVID-19 pandemic. Patients with COVID-19 had significantly higher 30-day mortality, intubation rates, and NIV failure compared to pre-pandemic patients with non-COVID respiratory failure.

Full summary

367 CHARS

NIV was used as primary respiratory support in 697 participants (35.1%). The study is limited by its observational design, differing indications for NIV between cohorts, and inability to account for pre-ICU respiratory support. These findings suggest that outcomes of very old ICU patients treated with NIV were worse during COVID-19 compared to the pre-pandemic era.

STUDY TYPE

cohort

SPECIALTY

critical care

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ORIGINAL PAPER

PMC10497468

Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic

Annals of Intensive Care

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ABSTRACT

Abstract 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. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-023-01173-2. Keywords: COVID-19, Older patients, Intensive care unit, Non-invasive ventilation, Respiratory failure

CITATION EXPORT

Kamil Polok, Jakub Fronczek, Bertrand Guidet et al.. Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic. Annals of Intensive Care. (2023). https://doi.org/10.1186/s13613-023-01173-2

AUTHORS

23 · 25 CENTRES

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, Brian Marsh, Finn H Andersen, Rui Moreno, Maurizio Cecconi, Hans Flaatten, Christian Jung, Wojciech Szczeklik

1Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30-901 Kraków, Poland
2Department of Pulmonology, Jagiellonian University Medical College, Kraków, Poland
3UMR_S 1136, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, UPMC Univ Paris 06, INSERMInstitut Pierre Louis d’Epidémiologie et de Santé PubliqueAssistance Publique - Hôpitaux de Paris, Sorbonne Universités, F-75012 Paris, France
4Critical Care Department, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain
5Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
6Department of Anaesthesia and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
7Department of Critical Care, St George’s Hospital, London, UK
8Medical Intensive Care Unit, Hadassah Medical Center, Jerusalem, Israel
9Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
10Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
11Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
12Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
13Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
14Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
15Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
16Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
17Mater Misericordiae University Hospital, Dublin, Ireland
18Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway
19Department of Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
20Faculdade de Ciências Médicas de Lisboa (Nova Médical School), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
21Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
22Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy
23Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
24Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
25Department of Clinical Medicine, University of Bergen, Bergen, Norway