The Impact of Different Ventilatory Strategies on Clinical Outcomes in Patients with COVID-19 Pneumonia

Rihards P Rocans; Agnese Ozolina; Denise Battaglini; Evita Bine; Janis V Birnbaums; Anastasija Tsarevskaya; Sintija Udre; Marija Aleksejeva; Biruta Mamaja; Paolo Pelosi

doi:10.3390/jcm11102710

The Impact of Different Ventilatory Strategies on Clinical Outcomes in Patients with COVID-19 Pneumonia

J Clin Med. 2022 May 11;11(10):2710. doi: 10.3390/jcm11102710.

Authors

Rihards P Rocans^{1

2}, Agnese Ozolina^{1

2}, Denise Battaglini³, Evita Bine^{1

4}, Janis V Birnbaums^{1

2}, Anastasija Tsarevskaya^{2

4}, Sintija Udre⁵, Marija Aleksejeva⁵, Biruta Mamaja^{1

2}, Paolo Pelosi^{3

6}

Affiliations

¹ Anesthesiology and Intensive Care Clinics, Riga East Clinical University Hospital, Hipokrata Street 2, LV-1079 Riga, Latvia.
² Department of Anaesthesia and Intensive Care, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia.
³ Anesthesiology and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy.
⁴ Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia.
⁵ Faculty of Medicine, University of Latvia, Raina Boulevard 19, LV-1586 Riga, Latvia.
⁶ Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16145 Genoa, Italy.

Abstract

Introduction: The aim was to investigate the impact of different ventilator strategies (non-invasive ventilation (NIV); invasive MV with tracheal tube (TT) and with tracheostomy (TS) on outcomes (mortality and intensive care unit (ICU) length of stay) in patients with COVID-19. We also assessed the impact of timing of percutaneous tracheostomy and other risk factors on mortality. Methods: The retrospective cohort included 868 patients with severe COVID-19. Demographics, MV parameters and duration, and ICU mortality were collected. Results: MV was provided in 530 (61.1%) patients, divided into three groups: NIV (n = 139), TT (n = 313), and TS (n = 78). Prevalence of tracheostomy was 14.7%, and ICU mortality was 90.4%, 60.2%, and 30.2% in TT, TS, and NIV groups, respectively (p < 0.001). Tracheostomy increased the chances of survival and being discharged from ICU (OR 6.3, p < 0.001) despite prolonging ICU stay compared to the TT group (22.2 days vs. 10.7 days, p < 0.001) without differences in survival rates between early and late tracheostomy. Patients who only received invasive MV had higher odds of survival compared to those receiving NIV in ICU prior to invasive MV (OR 2.7, p = 0.001). The odds of death increased with age (OR 1.032, p < 0.001), obesity (1.58, p = 0.041), chronic renal disease (1.57, p = 0.019), sepsis (2.8, p < 0.001), acute kidney injury (1.7, p = 0.049), multiple organ dysfunction (3.2, p < 0.001), and ARDS (3.3, p < 0.001). Conclusions: Percutaneous tracheostomy compared to MV via TT significantly increased survival and the rate of discharge from ICU, without differences between early or late tracheostomy.

Keywords: COVID-19; intensive care; percutaneous tracheostomy; tracheostomy.

Grants and funding

The authors declare that the article publication fee has been covered with the support of Educational Centre of Riga East University Hospital. No funders were involved in the study design, collection, analysis, interpretation of data or writing of this article.