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. 2022 Feb 8;12(1):10.
doi: 10.1186/s13613-022-00981-2.

Association of ventilator type with hospital mortality in critically ill patients with SARS-CoV2 infection: a prospective study

Alexis Ferré  1 , Fabien Marquion  2 , Marc Delord  3   4 , Antoine Gros  5 , Guillaume Lacave  5 , Virginie Laurent  5 , Sybille Merceron  5 , Marine Paul  5 , Christelle Simon  2 , Gilles Troché  5 , Clément Charbonnel  6 , Stéphanie Marque-Juillet  7 , Fabrice Bruneel  5 , Stéphane Legriel  5   8 ; RESPI-COVID19 Study Group
Collaborators, Affiliations

Association of ventilator type with hospital mortality in critically ill patients with SARS-CoV2 infection: a prospective study

Alexis Ferré et al. Ann Intensive Care. .

Abstract

Background: To evaluate the association between ventilator type and hospital mortality in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (SARS-CoV2 infection), a single-center prospective observational study in France.

Results: We prospectively included consecutive adults admitted to the intensive care unit (ICU) of a university-affiliated tertiary hospital for ARDS related to proven COVID-19, between March 2020 and July 2021. All patients were intubated. We compared two patient groups defined by whether an ICU ventilator or a less sophisticated ventilator such as a sophisticated turbine-based transport ventilator was used. Kaplan-Meier survival curves were plotted. Cox multivariate regression was performed to identify associations between patient characteristics and hospital mortality. We included 189 patients (140 [74.1%] men) with a median age of 65 years [IQR, 55-73], of whom 61 (32.3%) died before hospital discharge. By multivariate analysis, factors associated with in-hospital mortality were age ≥ 70 years (HR, 2.11; 95% CI, 1.24-3.59; P = 0.006), immunodeficiency (HR, 2.43; 95% CI, 1.16-5.09; P = 0.02) and serum creatinine ≥ 100 µmol/L (HR, 3.01; 95% CI, 1.77-5.10; P < 0.001) but not ventilator type. As compared to conventional ICU (equipped with ICU and anesthesiology ventilators), management in transient ICU (equipped with non-ICU turbine-based ventilators) was associated neither with a longer duration of invasive mechanical ventilation (18 [IQR, 11-32] vs. 21 [13-37] days, respectively; P = 0.39) nor with a longer ICU stay (24 [IQR, 14-40] vs. 27 [15-44] days, respectively; P = 0.44).

Conclusions: In ventilated patients with ARDS due to COVID-19, management in transient ICU equipped with non-ICU sophisticated turbine-based ventilators was not associated with worse outcomes compared to standard ICU, equipped with ICU ventilators. Although our study design is not powered to demonstrate any difference in outcome, our results after adjustment do not suggest any signal of harm when using these transport type ventilators as an alternative to ICU ventilators during COVID-19 surge.

Keywords: COVID-19; ICU; Mortality; Outcomes; Ventilator.

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Conflict of interest statement

None of the authors has any competing interest to declare.

Figures

Fig. 1
Fig. 1
Patient flowchart. SARS-CoV2 severe acute respiratory syndrome-coronavirus type 2, ARDS acute respiratory distress syndrome, ICU intensive care unit
Fig. 2
Fig. 2
Kaplan–Meier survival curves according to ventilator type in 189 patients with COVID-19-related acute respiratory distress syndrome. ICU intensive care unit
Fig. 3
Fig. 3
Multivariate analysis and forest plot: association of ventilator type and risk factors with risk of hospital mortality. Data marker sizes reflect the relative size of each covariate. Hazard ratios were computed after adjustment on the SAPS II. Error bars indicate 95% confidence intervals of hazard ratios. 95% CI denotes 95% confidence interval. ICU intensive care unit
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