Observational study of changes in utilization and outcomes in mechanical ventilation in COVID-19

PLoS ONE, vol. 17, pp. e0262315

Abstract

BACKGROUND: The role of non-invasive ventilation (NIV) in severe COVID-19 remains a matter of debate. Therefore, the utilization and outcome of NIV in COVID-19 in an unbiased cohort was determined. AIM: The aim was to provide a detailed account of hospitalized COVID-19 patients requiring non-invasive ventilation during their hospital stay. Furthermore, differences of patients treated with NIV between the first and second wave are explored. METHODS: Confirmed COVID-19 cases of claims data of the Local Health Care Funds with non-invasive and/or invasive mechanical ventilation (MV) in the spring and autumn pandemic period in 2020 were comparable analysed. RESULTS: Nationwide cohort of 17.023 cases (median/IQR age 71/61-80 years, 64% male) 7235 (42.5%) patients primarily received IMV without NIV, 4469 (26.3%) patients received NIV without subsequent intubation, and 3472 (20.4%) patients had NIV failure (NIV-F), defined by subsequent endotracheal intubation. The proportion of patients who received invasive MV decreased from 75% to 37% during the second period. Accordingly, the proportion of patients with NIV exclusively increased from 9% to 30%, and those failing NIV increased from 9% to 23%. Median length of hospital stay decreased from 26 to 21 days, and duration of MV decreased from 11.9 to 7.3 days. The NIV failure rate decreased from 49% to 43%. Overall mortality increased from 51% versus 54%. Mortality was 44% with NIV-only, 54% with IMV and 66% with NIV-F with mortality rates steadily increasing from 62% in early NIV-F (day 1) to 72% in late NIV-F (>4 days). CONCLUSIONS: Utilization of NIV rapidly increased during the autumn period, which was associated with a reduced duration of MV, but not with overall mortality. High NIV-F rates are associated with increased mortality, particularly in late NIV-F.

Authors 12

1. Christian Karagiannidis corresponding

   Witten/Herdecke University · Kliniken der Stadt Köln

   Affiliation as printed

   Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Center, Kliniken der Stadt Köln, Witten/Herdecke University Hospital, Cologne, Germany

2. Corinna Hentschker
   Affiliation as printed

   Research Institute of the Local Health Care Funds, Berlin, Germany

3. Michael Westhoff

   Witten/Herdecke University · Lungenklinik Hemer

   Affiliation as printed

   Department of Pneumology, Sleep and Critical Care Medicine, Lungenklinik Hemer, Hemer, Germany

   University Witten/Herdecke, Witten, Germany

4. Steffen Weber‐Carstens

   Stiftung Charité · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany

5. Uwe Janssens

   Sankt-Antonius-Hospital Eschweiler

   Affiliation as printed

   Medical Clinic and Medical Intensive Care Medicine, St.-Antonius Hospital, Eschweiler, Germany

6. Stefan Kluge

   University Medical Center Hamburg-Eppendorf

   Affiliation as printed

   University Medical Center Hamburg-Eppendorf, Hamburg, Germany

7. Michael A. Pfeifer

   University Hospital Regensburg · Klinik Donaustauf

   Affiliation as printed

   Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany

   Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany

8. Claudia Spies

   Stiftung Charité · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany

9. Tobias Welte

   Medizinische Hochschule Hannover

   Affiliation as printed

   Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany

10. Rolf Rossaint Aachen Department of Anesthesiology

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of Anesthesiology, University Hospital Aachen, RWTH Aachen, Aachen, Germany

11. Carina Mostert
    Affiliation as printed

    Research Institute of the Local Health Care Funds, Berlin, Germany

12. Wolfram Windisch

    Witten/Herdecke University · Kliniken der Stadt Köln

    Affiliation as printed

    Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Center, Kliniken der Stadt Köln, Witten/Herdecke University Hospital, Cologne, Germany