Association Between Early Invasive Mechanical Ventilation and Day-60 Mortality in Acute Hypoxemic Respiratory Failure Related to Coronavirus Disease-2019 Pneumonia

Claire Dupuis; Lila Bouadma; Etienne de Montmollin; Dany Goldgran-Toledano; Carole Schwebel; Jean Reignier; Mathilde Neuville; Moreno Ursino; Shidasp Siami; Stéphane Ruckly; Corinne Alberti; Bruno Mourvillier; Sébastien Bailly; Kévin Grapin; Virginie Laurent; Niccolo Buetti; Marc Gainnier; Bertrand Souweine; Jean-François Timsit

doi:10.1097/CCE.0000000000000329

Association Between Early Invasive Mechanical Ventilation and Day-60 Mortality in Acute Hypoxemic Respiratory Failure Related to Coronavirus Disease-2019 Pneumonia

Crit Care Explor. 2021 Jan 22;3(1):e0329. doi: 10.1097/CCE.0000000000000329. eCollection 2021 Jan.

Authors

Claire Dupuis^{1

2}, Lila Bouadma^{2

3}, Etienne de Montmollin^{2

3}, Dany Goldgran-Toledano⁴, Carole Schwebel⁵, Jean Reignier⁶, Mathilde Neuville⁷, Moreno Ursino^{8

9}, Shidasp Siami¹⁰, Stéphane Ruckly¹¹, Corinne Alberti¹², Bruno Mourvillier¹³, Sébastien Bailly¹⁴, Kévin Grapin¹, Virginie Laurent¹⁵, Niccolo Buetti², Marc Gainnier¹⁶, Bertrand Souweine¹, Jean-François Timsit^{2

3}

Affiliations

¹ Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France.
² Université de Paris, UMR 1137, IAME, Paris, France.
³ AP-HP, Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard Hospital, Paris, France.
⁴ Polyvalent ICU, Groupe Hospitalier Intercommunal Le Raincy Montfermeil, Montfermeil, France.
⁵ Medical Intensive Care Unit, Grenoble University Hospital, La Tronche, France.
⁶ Medical Intensive Care Unit, Nantes University Hospital, Nantes, France.
⁷ Polyvalent ICU, Hôpital Foch, Suresnes, France.
⁸ F-CRIN PARTNERS Platform, AP-HP, Université de Paris, Paris, France.
⁹ Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université de Paris, Paris, France.
¹⁰ Polyvalent ICU, Centre Hospitalier Sud Essonne Dourdan-Etampes, Étampes, France.
¹¹ Department of Biostatistics, ICUREsearch, Paris, France.
¹² AP-HP, Epidemiology, Hôpital Robert Debré, Paris, France.
¹³ Medical Intensive Care Unit, Robert Debré University Hospital, Reims, France.
¹⁴ University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France.
¹⁵ Medical-Surgical Intensive Care Unit, André Mignot Hospital, Le Chesnay, France.
¹⁶ AP-HM, Intensive Care Unit, La Timone University Hospital, Marseilles, France.

Abstract

Objectives: About 5% of patients with coronavirus disease-2019 are admitted to the ICU for acute hypoxemic respiratory failure. Opinions differ on whether invasive mechanical ventilation should be used as first-line therapy over noninvasive oxygen support. The aim of the study was to assess the effect of early invasive mechanical ventilation in coronavirus disease-2019 with acute hypoxemic respiratory failure on day-60 mortality.

Design: Multicenter prospective French observational study.

Setting: Eleven ICUs of the French OutcomeRea network.

Patients: Coronavirus disease-2019 patients with acute hypoxemic respiratory failure (Pao₂/Fio₂ ≤ 300 mm Hg), without shock or neurologic failure on ICU admission, and not referred from another ICU or intermediate care unit were included.

Intervention: We compared day-60 mortality in patients who were on invasive mechanical ventilation within the first 2 calendar days of the ICU stay (early invasive mechanical ventilation group) and those who were not (nonearly invasive mechanical ventilation group). We used a Cox proportional-hazard model weighted by inverse probability of early invasive mechanical ventilation to determine the risk of death at day 60.

Measurement and main results: The 245 patients included had a median (interquartile range) age of 61 years (52-69 yr), a Simplified Acute Physiology Score II score of 34 mm Hg (26-44 mm Hg), and a Pao₂/Fio₂ of 121 mm Hg (90-174 mm Hg). The rates of ICU-acquired pneumonia, bacteremia, and the ICU length of stay were significantly higher in the early (n = 117 [48%]) than in the nonearly invasive mechanical ventilation group (n = 128 [52%]), p < 0.01. Day-60 mortality was 42.7% and 21.9% in the early and nonearly invasive mechanical ventilation groups, respectively. The weighted model showed that early invasive mechanical ventilation increased the risk for day-60 mortality (weighted hazard ratio =1.74; 95% CI, 1.07-2.83, p=0.03).

Conclusions: In ICU patients admitted with coronavirus disease-2019-induced acute hypoxemic respiratory failure, early invasive mechanical ventilation was associated with an increased risk of day-60 mortality. This result needs to be confirmed.

Keywords: acute hypoxemic respiratory failure; coronavirus disease 2019; critically ill; invasive mechanical ventilation; mortality; noninvasive oxygen support.