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. 2023;102(9):833-842.
doi: 10.1159/000533522. Epub 2023 Sep 5.

Analysis of an Individualised Stepwise Approach to Non-Pharmacological Therapy in COVID-19

Sandhya Matthes  1 , Johannes Holl  2 , Johannes Randerath  2 , Marcel Treml  2 , Michael Bockover  2 , Simon Herkenrath  2 , Lars Hagmeyer  2 , Johannes Knoch  2 , Ulrike Oesterlee  2 , Georgios Sofianos  2 , Winfried Randerath  2
Affiliations

Analysis of an Individualised Stepwise Approach to Non-Pharmacological Therapy in COVID-19

Sandhya Matthes et al. Respiration. 2023.

Abstract

Background: Early intubation versus use of conventional or high-flow nasal cannula oxygen therapy (COT/HFNC), continuous positive airway pressure (CPAP), and non-invasive ventilation (NIV) has been debated throughout the COVID-19 pandemic. Our centre followed a stepwise approach, in concordance with German national guidelines, escalating non-invasive modalities prior to invasive mechanical ventilation (IMV) or extracorporeal membrane oxygenation (ECMO), rather than early or late intubation.

Objectives: The aims of the study were to investigate the real-life usage of these modalities and analyse patient characteristics and survival.

Method: A retrospective monocentric observation was conducted of all consecutive COVID-19 hospital admissions between March 2020 and December 2021 at a university-affiliated pulmonary centre in Germany. Anthropometric data, therapy, and survival status were descriptively analysed.

Results: From 1,052 COVID-19-related admissions, 835 patients were included (54% male, median 58 years). Maximum therapy was as follows: 34% (n = 284) no therapy, 40% (n = 337) COT, 3% (n = 22) HFNC, 9% (n = 73) CPAP, 7% (n = 56) NIV, 4% (n = 34) IMV, and 3% (n = 29) ECMO. Of 551 patients treated with at least COT, 12.3% required intubation. Overall, 183 patients required intensive unit care, and 106 (13%) died. Of the 68 patients who received IMV/ECMO, 48 died (74%). The strategy for non-pharmacological therapy was individual but remained consistent throughout the studied period.

Conclusions: This study provides valuable insight into COVID-19 care in Germany and shows how the majority of patients could be treated with the maximum treatment required according to disease severity following the national algorithm. Escalation of therapy modality is interlinked with disease severity and thus associated with mortality.

Keywords: Acute respiratory failure; Critical care; Hypoxaemia; Intensive care unit; coronavirus.

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Conflict of interest statement

W.R. reports grants and personal fees from Philips Respironics, Loewenstein Medical, Resmed, Bayer Vital, Bioprojet, and Vanda Pharma, outside the submitted work. L.H. reports grants and personal fees from Boehringer, Pfizer, Roche, Novartis, AstraZeneca, and Chiesi, outside the submitted work. S.M., J.H., J.R., M.T., G.S., M.B., J.K., U.O., and S.H. have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Flow diagram showing eligibility for case analysis in the observational study.
Fig. 2.
Fig. 2.
The percentage use of non-pharmacological therapy in the period of March 2020 until December 2021 in relation to the overall number of hospital admissions for COVID-19 at the studied centre for all patients (a) and in n = 551 receiving at least oxygen therapy (b). COT, conventional oxygen therapy; HFNC, high-flow nasal cannula; CPAP, continuous positive airway pressure; NIV, non-invasive ventilation; IMV, invasive mechanical ventilation; ECMO, extracorporeal membrane oxygenation.
Fig. 3.
Fig. 3.
The number of hospital admission per week for COVID-19 at the studied centre (orange bars) in relation to average weekly admission for COVID-19 across Germany (blue line) over time. Source: European Centre for Disease Prevention and Control [25].
Fig. 4.
Fig. 4.
Individual therapy pathway for the use of non-pharmacological therapy in the 835 in-patient COVID-19 patients within the studied period. COT, conventional oxygen therapy; HFNC, high-flow nasal cannula; CPAP, continuous positive airway pressure; NIV, non-invasive ventilation; IMV, invasive mechanical ventilation; ECMO, extracorporeal membrane oxygenation.
See this image and copyright information in PMC

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