Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec 30:12:1421-1431.
doi: 10.2147/CLEP.S278709. eCollection 2020.

Sixty-Day Mortality Among 520 Italian Hospitalized COVID-19 Patients According to the Adopted Ventilatory Strategy in the Context of an Integrated Multidisciplinary Clinical Organization: A Population-Based Cohort Study

Antonella Potalivo #  1 , Jonathan Montomoli #  1 , Francesca Facondini  1 , Gianfranco Sanson  2 , Luigi Arcangelo Lazzari Agli  3   4 , Tiziana Perin  5 , Francesco Cristini  6 , Enrico Cavagna  7 , Raffaella De Giovanni  8 , Carlo Biagetti  6 , Ilaria Panzini  9 , Cinzia Ravaioli  10 , Maria Maddalena Bitondo  1 , Daniela Guerra  1 , Giovanni Giuliani  1 , Elena Mosconi  1 , Sonia Guarino  1 , Elisa Marchionni  6 , Gianfilippo Gangitano  5 , Ilaria Valentini  3   4 , Luca Giampaolo  8 , Francesco Muratore  7 , Giuseppe Nardi  1
Affiliations

Sixty-Day Mortality Among 520 Italian Hospitalized COVID-19 Patients According to the Adopted Ventilatory Strategy in the Context of an Integrated Multidisciplinary Clinical Organization: A Population-Based Cohort Study

Antonella Potalivo et al. Clin Epidemiol. .

Abstract

Purpose: Although the decision of which ventilation strategy to adopt in COVID-19 patients is crucial, yet the most appropriate means of carrying out this undertaking is not supported by strong evidence. We therefore described the organization of a province-level healthcare system during the occurrence of the COVID-19 epidemic and the 60-day outcomes of the hospitalized COVID-19 patients according to the respiratory strategy adopted given the limited available resources.

Patients and methods: All COVID-19 patients (26/02/2020-18/04/2020) in the Rimini Province of Italy were included in this population-based cohort study. The hospitalized patients were classified according to the maximum level of respiratory support: oxygen supplementation (Oxygen group), non-invasive ventilation (NIV-only group), invasive mechanical ventilation (IMV-only group), and IMV after an NIV trial (IMV-after-NIV group). Sixty-day mortality risk was estimated with a Cox proportional hazard analysis adjusted by age, sex, and administration of steroids, canakinumab, and tocilizumab.

Results: We identified a total of 1,424 symptomatic patients: 520 (36.5%) were hospitalized, while 904 (63.5%) were treated at home with no 60-day deaths. Based on the respiratory support, 408 (78.5%) were assigned to the Oxygen group, 46 (8.8%) to the NIV-only group, 25 (4.8%) to the IMV-after-NIV group, and 41 (7.9%) to the IMV-only group. There was no significant difference in the PaO2/FiO2 at IMV inception in the IMV-after-NIV and IMV-only groups (p=0.9). Overall 60-day mortality was 24.2% (Oxygen: 23.0%; NIV-only: 19.6%; IMV-after-NIV: 32.0%; IMV-only: 36.6%; p=0.165). Compared with the Oxygen group, the adjusted 60-day mortality risk significantly increased in the IMV-after-NIV (HR 2.776; p=0.024) and IMV-only groups (HR 2.966; p=0.001).

Conclusion: This study provided a population-based estimate of the impact of the COVID-19 outbreak in a severely affected Italian province. A similar 60-day mortality risk was found for patients undergoing immediate IMV and those intubated after an NIV trial with favorable outcomes after prolonged IMV.

Keywords: ARDS; COVID-19; mechanical ventilation; mortality; multidisciplinary team approach; noninvasive ventilation.

PubMed Disclaimer

Conflict of interest statement

Jonathan Montomoli reports personal fees from Active Medical BV, outside the submitted work. The authors report no other potential conflicts of interest for this work.

Figures

Figure 1
Figure 1
Flow chart synthesizing the clinical pathways of the COVID-19 patients, the respiratory support provided at each step of their hospital stay, and their 60-day mortality. Percentages refer to the previous level in the flow chart, unless otherwise indicated. *With respect to total hospital admissions.
Figure 2
Figure 2
(A) Duration of continuous non-invasive ventilation (NIV) for patients who received at least one trial of NIV (n=71). (B) Interval between hospital admission and the onset of invasive mechanical ventilation (IMV) for patients admitted to the intensive care unit (n=66). (C) Length of IMV in patients who survived or died at the 60-day follow-up.
Figure 3
Figure 3
Crude (A) and adjusted (B) Kaplan–Meier curves for the risk of 60-day mortality in patients belonging to the study groups according to the provided respiratory support.
See this image and copyright information in PMC

References

    1. Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–1720. doi:10.1056/NEJMoa2002032 - DOI - PMC - PubMed
    1. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA. 2020;323(20):2052. doi:10.1001/jama.2020.6775 - DOI - PMC - PubMed
    1. Karagiannidis C, Mostert C, Hentschker C, et al. Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study. Lancet Respirat Med. 2020;8(9):853–862. doi:10.1016/S2213-2600(20)30316-7 - DOI - PMC - PubMed
    1. Auld SC, Caridi-Scheible M, Blum JM, et al. ICU and ventilator mortality among critically ill adults with coronavirus disease 2019. Crit Care Med. 2020. doi:10.1097/CCM.0000000000004457 - DOI - PMC - PubMed
    1. ICNARC. Intensive Care National Audit & Research Centre (ICNARC) report on COVID-19 in critical care - 17 July 2020. Available from: https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports. Accessed August24, 2020.

LinkOut - more resources