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Minerva Anestesiologica 2022 July-August;88(7-8):580-7

DOI: 10.23736/S0375-9393.22.16094-3


lingua: Inglese

Endotracheal intubation rate is lower with additional face-mask noninvasive ventilation for critically-ill SARS-CoV-2 patients requiring high-flow nasal oxygen: a retrospective bicentric cohort with propensity score analysis

Tomas URBINA 1, 2 , Alexandre ELABBADI 2, 3, 4, Paul GABARRE 1, 2, 3, Naike BIGÉ 1, 2, Matthieu TURPIN 2, 3, 4, Vincent BONNY 1, 2, Cyrielle DESNOS 2, 4, Jean-Luc BAUDEL 1, 2, Jean-Remi LAVILLEGRAND 1, 2, 3, Geoffroy HARIRI 1, 2, 3, Muriel FARTOUKH 2, 3, 4, Bertrand GUIDET 1, 2, 3, Eric MAURY 1, 2, 3, Guillaume DUMAS 2, 5, Guillaume VOIRIOT 2, 3, 4, Hafid AIT-OUFELLA 1, 2, 3, 6

1 Intensive Care Unit, Saint-Antoine Hospital, Paris, France; 2 Assistance Publique-Hôpitaux de Paris, Paris, France; 3 Sorbonne University, Paris, France; 4 Intensive Care Unit, Tenon Hospital, Paris, France; 5 Intensive Care Unit, Saint-Louis Hospital, Paris, France; 6 Inserm U970, Cardiovascular Research Center, University of Paris, Paris, France

BACKGROUND: SARS-CoV-2 pneumonia is responsible for unprecedented numbers of acute respiratory failure requiring invasive mechanical ventilation (IMV). This work aimed to assess whether adding face-mask noninvasive ventilation (NIV) to high-flow nasal oxygen (HFNO) was associated with a reduced need for endotracheal intubation.
METHODS: This retrospective cohort study was conducted from July 2020 to January 2021 in two tertiary care intensive care units (ICUs) in Paris, France. Patients admitted for laboratory confirmed SARS-CoV-2 infection with acute hypoxemic respiratory failure requiring HFNO with or without NIV were included. The primary outcome was the rate of endotracheal intubation. Secondary outcomes included day-28 mortality, day-28 respiratory support and IMV free days, ICU and hospital length-of-stay. Sensitivity analyses with both propensity score matching and overlap weighting were used.
RESULTS: One hundred twenty-eight patients were included, 88 (69%) received HFNO alone and 40 (31%) received additional NIV. Additional NIV was associated with a reduced rate of endotracheal intubation in multivariate analysis (53 [60%] vs. 15 [38%], HR=0.46 [95% CI: 0.23-0.95], P=0.04). Sensitivity analyses by propensity score matching (HR=0.45 [95% CI: 0.24-0.84], P=0.01) and overlap weighting (HR=0.52 [95% CI: 0.28-0.94], P=0.03) were consistent. Day-28 mortality was 25 (28%) in the HFNO group and 8 (20%) in the NIV group (HR=0.75 [95% CI: 0.15-3.82], P=0.72). NIV was associated with higher IMV free days (20 [0-28] vs. 28 [14-28], P=0.015). All sensitivity analyses were consistent regarding secondary outcomes.
CONCLUSIONS: Need for endotracheal intubation was lower in critically-ill SARS-CoV-2 patients receiving face-mask noninvasive mechanical ventilation in addition to high-flow oxygen therapy.

KEY WORDS: Critical care; COVID-19; Oxygen inhalation therapy; Intubation; Noninvasive ventilation; SARS-CoV-2

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