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
Observational Study
. 2022 Jul 22;26(1):224.
doi: 10.1186/s13054-022-04082-1.

Noninvasive ventilation in COVID-19 patients aged ≥ 70 years-a prospective multicentre cohort study

Kamil Polok  1   2 , Jakub Fronczek  1 , Antonio Artigas  3 , Hans Flaatten  4   5 , Bertrand Guidet  6   7 , Dylan W De Lange  8 , Jesper Fjølner  9 , Susannah Leaver  10 , Michael Beil  11 , Sigal Sviri  12 , Raphael Romano Bruno  13 , Bernhard Wernly  14   15 , Bernardo Bollen Pinto  16 , Joerg C Schefold  17 , Dorota Studzińska  1 , Michael Joannidis  18 , Sandra Oeyen  19 , Brian Marsh  20 , Finn H Andersen  21   22 , Rui Moreno  23   24 , Maurizio Cecconi  25   26 , Christian Jung  13 , Wojciech Szczeklik  27 ; COVIP Study Group
Collaborators, Affiliations
Observational Study

Noninvasive ventilation in COVID-19 patients aged ≥ 70 years-a prospective multicentre cohort study

Kamil Polok et al. Crit Care. .

Abstract

Background: Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV.

Methods: This is a substudy of COVIP study-an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality.

Results: Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36-5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06-2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI - 2.27 to - 0.46 days) compared to primary IMV group (n = 1876).

Conclusions: Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV. Clinical Trial Registration NCT04321265 , registered 19 March 2020, https://clinicaltrials.gov .

Keywords: COVID-19; Elderly; Frailty; Intensive care unit; Noninvasive ventilation.

PubMed Disclaimer

Conflict of interest statement

Joerg C. Schefold declares that the Dept. of Intensive Care Medicine Bern has/had research and/or development/consulting contracts with (full disclosure): Orion Corporation, Abbott Nutrition International, B. Braun Medical AG, CSEM SA, Edwards Lifesciences Services GmbH/SA, Kenta Biotech Ltd, Maquet Critical Care AB, Omnicare Clinical Research AG, and Nestlé. Educational grants were received from Fresenius Kabi; GSK; MSD; Lilly; Baxter; Astellas; AstraZeneca; B. Braun Medical AG, CSL Behring, Maquet, Novartis, Covidien, Nycomed, Pierre Fabre Pharma (Roba Pharma); Pfizer, Orion Pharma. The money went into departmental funds. No personal financial gain applies. All other authors do not have any conflict of interest to declare related to this manuscript.

Figures

Fig. 1
Fig. 1
Study flowchart
Fig. 2
Fig. 2
Association between pre-intubation NIV duration and 30-day mortality. Black line represents OR point estimate across NIV duration prior to endotracheal intubation, while grey areas depicts 95% confidence interval
Fig. 3
Fig. 3
Kaplan–Meier curve for comparison of 30-day mortality between primary NIV and primary IMV group
See this image and copyright information in PMC

Comment in

References

    1. Blumenthal D, Fowler EJ, Abrams M, Collins SR. Covid-19—implications for the health care system. N Engl J Med. 2020;383(15):1483–1488. doi: 10.1056/NEJMsb2021088. - DOI - PubMed
    1. Sterne JAC, Murthy S, Diaz JV, Slutsky AS, Villar J, Angus DC, et al. Association between administration of systemic corticosteroids and mortality among critically Ill patients with COVID-19: a meta-analysis. J Am Med Assoc. 2020;324(13):1330–1341. doi: 10.1001/jama.2020.17023. - DOI - PMC - PubMed
    1. Group TWHOREA for C-19 T (REACT) W Association between administration of IL-6 antagonists and mortality among patients hospitalized for COVID-19: a meta-analysis. JAMA. 2021;326(6):499–518. doi: 10.1001/jama.2021.11330. - DOI - PMC - PubMed
    1. Barda N, Dagan N, Ben-Shlomo Y, Kepten E, Waxman J, Ohana R, et al. Safety of the BNT162b2 mRNA Covid-19 vaccine in a nationwide setting. N Engl J Med. 2021;385(12):1078–1090. doi: 10.1056/NEJMoa2110475. - DOI - PMC - PubMed
    1. Osuchowski MF, Winkler MS, Skirecki T, Cajander S, Shankar-Hari M, Lachmann G, et al. The COVID-19 puzzle: deciphering pathophysiology and phenotypes of a new disease entity. Lancet Respir Med. 2021;9(6):622–642. doi: 10.1016/S2213-2600(21)00218-6. - DOI - PMC - PubMed

Publication types

Associated data