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Title: Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID): a national, multicentre, observational cohort study.
Austin Authors: Botta, Michela;Tsonas, Anissa M;Pillay, Janesh;Boers, Leonoor S;Algera, Anna Geke;Bos, Lieuwe D J;Dongelmans, Dave A;Hollmann, Marcus W;Horn, Janneke;Vlaar, Alexander P J;Schultz, Marcus J;Serpa Neto, Ary ;Paulus, Frederique
Affiliation: Department of Intensive Care, Amsterdam University Medical Centers location Academic Medical Center, Amsterdam, Netherlands
Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Austin Health
University Medical Center Groningen, Groningen, The Netherlands
Department of Anaesthesiology, Amsterdam University Medical Centers location Academic Medical Center, Amsterdam, Netherlands
University of Melbourne, Melbourne, VIC, Australia
Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
ACHIEVE, Centre of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, Netherlands
Nuffield Department of Medicine, University of Oxford, Oxford, UK
Issue Date: 23-Oct-2020
Date: 2020-10-23
Publication information: The Lancet. Respiratory Medicine 2021; 9(2): 139-148
Abstract: Little is known about the practice of ventilation management in patients with COVID-19. We aimed to describe the practice of ventilation management and to establish outcomes in invasively ventilated patients with COVID-19 in a single country during the first month of the outbreak. PRoVENT-COVID is a national, multicentre, retrospective observational study done at 18 intensive care units (ICUs) in the Netherlands. Consecutive patients aged at least 18 years were eligible for participation if they had received invasive ventilation for COVID-19 at a participating ICU during the first month of the national outbreak in the Netherlands. The primary outcome was a combination of ventilator variables and parameters over the first 4 calendar days of ventilation: tidal volume, positive end-expiratory pressure (PEEP), respiratory system compliance, and driving pressure. Secondary outcomes included the use of adjunctive treatments for refractory hypoxaemia and ICU complications. Patient-centred outcomes were ventilator-free days at day 28, duration of ventilation, duration of ICU and hospital stay, and mortality. PRoVENT-COVID is registered at (NCT04346342). Between March 1 and April 1, 2020, 553 patients were included in the study. Median tidal volume was 6·3 mL/kg predicted bodyweight (IQR 5·7-7·1), PEEP was 14·0 cm H2O (IQR 11·0-15·0), and driving pressure was 14·0 cm H2O (11·2-16·0). Median respiratory system compliance was 31·9 mL/cm H2O (26·0-39·9). Of the adjunctive treatments for refractory hypoxaemia, prone positioning was most often used in the first 4 days of ventilation (283 [53%] of 530 patients). The median number of ventilator-free days at day 28 was 0 (IQR 0-15); 186 (35%) of 530 patients had died by day 28. Predictors of 28-day mortality were gender, age, tidal volume, respiratory system compliance, arterial pH, and heart rate on the first day of invasive ventilation. In patients with COVID-19 who were invasively ventilated during the first month of the outbreak in the Netherlands, lung-protective ventilation with low tidal volume and low driving pressure was broadly applied and prone positioning was often used. The applied PEEP varied widely, despite an invariably low respiratory system compliance. The findings of this national study provide a basis for new hypotheses and sample size calculations for future trials of invasive ventilation for COVID-19. These data could also help in the interpretation of findings from other studies of ventilation practice and outcomes in invasively ventilated patients with COVID-19. Amsterdam University Medical Centers, location Academic Medical Center.
DOI: 10.1016/S2213-2600(20)30459-8
Journal: The Lancet. Respiratory Medicine
PubMed URL: 33169671
Type: Journal Article
Subjects: COVID-19
Appears in Collections:Journal articles

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