The Relationship between the Type of Respiratory Support and Its Outcomes in Patients with COVID-19 Hospitalized in the Intensive Care Units

Teloori, Parastou; Kordestani-Moghadam, Parastou; Mohammadi, Rasool; Heidarizadeh, Khadijeh

doi:10.22087/ijac.2022.465265.1015

The Relationship between the Type of Respiratory Support and Its Outcomes in Patients with COVID-19 Hospitalized in the Intensive Care Units

Document Type : Research

Authors

Parastou Teloori ¹

Parastou Kordestani-Moghadam ²

Rasool Mohammadi ³

Khadijeh Heidarizadeh ²

¹ Student Research Committee, Nursing and Midwifery School, Lorestan University of Medical Sciences, Khorramabad, Iran.

² Critical Care and Emergency Nursing, Faculty of Nursing & Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran

³ Nutritional Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran

10.22087/ijac.2022.465265.1015

Abstract

Given the unknown nature of the COVID-19 and the ambiguity surrounding the efficacy of various methods of treatment, the present study aimed to elucidate the correlation between the type of respiratory support administered and the resultant outcomes for patients with COVID-19 who were admitted to the intensive care units. In this retrospective cohort patients’ records were categorized into two groups based on the type of respiratory support method employed: those who were solely intubated and those who received a combined mechanical ventilation approach utilizing an oxygen mask and intubation non-invasive ventilation plus intubation. The instrument used for collecting data comprised a form that encompassed demographic details alongside a history of pre-existing conditions and parameters pertinent to the patient's health status. A comprehensive examination of 260 files was conducted. Approximately 46% of the patients were categorized within the intubated group. The findings indicated that, the mean arterial oxygen levels were recorded at four distinct time points-upon hospital admission, upon ICU admission, prior to ventilator support, and following ventilator support- were statistically significant difference (P<0.001). The mean duration of hospitalization for the intubated group was markedly less than that of the group receiving NIV plus intubation (P < 0.001). The mean duration of being connected to a ventilator among the groups under investigation did not yield a statistically significant result. The analysis demonstrated no statistically significant difference in mortality rates between the two groups. Furthermore, examining survival curves revealed a statistically significant distinction between the two groups (P < 0.001). The results partially depend upon potential disparities in the effectiveness of invasive versus non-invasive methods. Consequently, further research in this domain appears imperative to corroborate a more robust endorsement for non-invasive techniques—attributable to their reduced side effects, user-friendliness, minimal training requirements, and broader clinical applicability.

Keywords

Covid-19

Non-Invasive Ventilation

Oxygen therapy

Intubation

Respiratory Support

1. Vetter P, Vu DL, L’Huillier AG, Schibler M, Kaiser L, Jacquerioz F. Clinical features of covid-19. Bmj. 2020 Apr 17;369.
2. Windisch W, Weber-Carstens S, Kluge S, Rossaint R, Welte T, Karagiannidis C. Invasive and non-invasive ventilation in patients with COVID-19. Deutsches Ärzteblatt International. 2020 Aug 3;117(31-32):528.
3. Wendel Garcia PD, Aguirre-Bermeo H, Buehler PK, Alfaro-Farias M, Yuen B, David S, Tschoellitsch T, Wengenmayer T, Korsos A, Fogagnolo A, Kleger GR. Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort. Critical care. 2021 May 25;25(1):175.
4. Yang X, Yu Y, Xu J, Shu H, Xia JA, Liu H, Wu Y, Zhang L, Yu Z, Fang M, Yu T. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The lancet respiratory medicine. 2020 May 1;8(5):475-81.
5. Barani N, Bahramnezhad F. A Review of the use of non-invasive ventilation in Covid-19 disease. Iranian Journal Of Anaesthesiology and Critical Care, 2021 2021;43(4):1-6.
6. Tobin MJ, Laghi F, Jubran A. Caution about early intubation and mechanical ventilation in COVID-19. Annals of intensive care. 2020 Dec;10:1-3.
7. Longhini F, Bruni A, Garofalo E, Navalesi P, Grasselli G, Cosentini R, Foti G, Mattei A, Ippolito M, Accurso G, Vitale F. Helmet continuous positive airway pressure and prone positioning: A proposal for an early management of COVID-19 patients. Pulmonology. 2020 Jul 1;26(4):186-91.
8. Lucchini A, Giani M, Isgrò S, Rona R, Foti G. WITHDRAWN: The “Helmet bundle” in COVID-2019 patients undergoing non invasive ventilation. Intensive and Critical Care Nursing. 2020 Apr 24:102875.
9. Daniel P, Mecklenburg M, Massiah C, Joseph MA, Wilson C, Parmar P, Rosengarten S, Maini R, Kim J, Oomen A, Zehtabchi S. Non-invasive positive pressure ventilation versus endotracheal intubation in treatment of COVID-19 patients requiring ventilatory support. The American journal of emergency medicine. 2021 May 1;43:103-8.
10. Faraone A, Beltrame C, Crociani A, Carrai P, Lovicu E, Filetti S, Sbaragli S, Alessi C, Cameron Smith M, Angotti C, Fortini A. Effectiveness and safety of noninvasive positive pressure ventilation in the treatment of COVID-19-associated acute hypoxemic respiratory failure: a single center, non-ICU setting experience. Internal and emergency medicine. 2021 Aug;16(5):1183-90.
11. Boscolo A, Pasin L, Sella N, Pretto C, Tocco M, Tamburini E, Rosi P, Polati E, Donadello K, Gottin L, Vianello A. Outcomes of COVID-19 patients intubated after failure of non-invasive ventilation: a multicenter observational study. Scientific reports. 2021 Sep 6;11(1):17730.
12. Tonelli R, Fantini R, Tabbì L, Castaniere I, Pisani L, Pellegrino MR, Della Casa G, D’Amico R, Girardis M, Nava S, Clini EM. Early inspiratory effort assessment by esophageal manometry predicts noninvasive ventilation outcome in de novo respiratory failure. A pilot study. American journal of respiratory and critical care medicine. 2020 Aug 15;202(4):558-67.
13. Dreher M, Kersten A, Bickenbach J, Balfanz P, Hartmann B, Cornelissen C, Daher A, Stöhr R, Kleines M, Lemmen SW, Brokmann JC. The characteristics of 50 hospitalized COVID-19 patients with and without ARDS. Deutsches Ärzteblatt International. 2020 Apr 17;117(16):271.
14. Papoutsi E, Giannakoulis VG, Xourgia E, Routsi C, Kotanidou A, Siempos II. Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies. Critical Care. 2021 Dec;25:1-9.
15. Mohammadi M, Khamseh AK, Varpaei HA. Invasive Airway" Intubation" in COVID-19 Patients; Statistics, Causes, and Recommendations: A Review Article. Anesthesiology and pain medicine. 2021 Jul 9;11(3):e115868.
16. Carter C, Aedy H, Notter J. COVID-19 disease: Non-Invasive Ventilation and high frequency nasal oxygenation. Clinics in Integrated Care. 2020 Jul 1;1:100006.
17. Radovanovic D, Coppola S, Franceschi E, Gervasoni F, Duscio E, Chiumello DA, Santus P. Mortality and clinical outcomes in patients with COVID-19 pneumonia treated with non-invasive respiratory support: a rapid review. Journal of critical care. 2021 Oct 1;65:1-8.