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https://www.arca.fiocruz.br/handle/icict/55747
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ArtigoDireito Autoral
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- INI - Artigos de Periódicos [3397]
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RESPIRATORY SUPPORT IN PATIENTS WITH SEVERE COVID-19 IN THE INTERNATIONAL SEVERE ACUTE RESPIRATORY AND EMERGING INFECTION (ISARIC) COVID-19 STUDY: A PROSPECTIVE, MULTINATIONAL, OBSERVATIONAL STUDY
Critical care
High flow nasal cannula
Invasive mechanical ventilation
Autor(es)
Reyes, Luis Felipe
Murthy, Srinivas
Garcia-Gallo, Esteban
Merson, Laura
Ibáñez-Prada, Elsa D.
Rello, Jordi
Fuentes, Yuli V.
Martin-Loeches, Ignacio
Bozza, Fernando
Duque, Sara
Taccone, Fabio S.
Fowler, Robert A.
Kartsonaki, Christiana
Gonçalves, Bronner P.
Citarella, Barbara Wanjiru
Aryal, Diptesh
Burhan, Erlina
Cummings, Matthew J.
Delmas, Christelle
Diaz, Rodrigo
Figueiredo-Mello, Claudia
Hashmi, Madiha
Panda, Prasan Kumar
Jiménez, Miguel Pedrera
Rincon, Diego Fernando Bautista
Thomson, David
Nichol, Alistair
Marshall, John C.
Olliaro, Piero L.
Murthy, Srinivas
Garcia-Gallo, Esteban
Merson, Laura
Ibáñez-Prada, Elsa D.
Rello, Jordi
Fuentes, Yuli V.
Martin-Loeches, Ignacio
Bozza, Fernando
Duque, Sara
Taccone, Fabio S.
Fowler, Robert A.
Kartsonaki, Christiana
Gonçalves, Bronner P.
Citarella, Barbara Wanjiru
Aryal, Diptesh
Burhan, Erlina
Cummings, Matthew J.
Delmas, Christelle
Diaz, Rodrigo
Figueiredo-Mello, Claudia
Hashmi, Madiha
Panda, Prasan Kumar
Jiménez, Miguel Pedrera
Rincon, Diego Fernando Bautista
Thomson, David
Nichol, Alistair
Marshall, John C.
Olliaro, Piero L.
Afiliação
University of Oxford. Pandemic Sciences Institute. Oxford, UK / Universidad de La Sabana. Infectious Diseases Department. Chía, Colombia / Clínica Universidad de La Sabana. Critical Care Department. Chía, Colombia.
University of British Columbia. Department of Pediatrics. Vancouver, Canada.
Universidad de La Sabana. Infectious Diseases Department. Chía, Colombia.
University of Oxford. Pandemic Sciences Institute. Oxford, UK.
Universidad de La Sabana. Infectious Diseases Department. Chía, Colombia / Clínica Universidad de La Sabana. Critical Care Department. Chía, Colombia.
Vall d'Hebron Institute of Research. Clinical Research Epidemiology in Pneumonia & Sepsis. Barcelona, Spain / Instituto de Salud Carlos III. Centro de Investigación Biomédica En Red de Enfermedades Respiratorias. Madrid, Spain.
Universidad de La Sabana. Infectious Diseases Department. Chía, Colombia / Clínica Universidad de La Sabana. Critical Care Department. Chía, Colombia.
Multidisciplinary Intensive Care Research Organization. Department of Clinical Medicine, St James's Hospital. Dublin, Ireland.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Brazilian Research in Intensive Care Network. Rio de Janeiro, RJ, Brazil.
Universidad de La Sabana. Infectious Diseases Department. Chía, Colombia.
Université Libre de Bruxelles. Department of Intensive Care. Brussels, Belgium / Hôpital Erasme. Department of Intensive Care. Laboratoire de Recherche Experimentale. Brussels, Belgium.
University of Toronto. Interdepartmental Division of Critical Care Medicine. Toronto, ON, Canada.
University of Oxford. Pandemic Sciences Institute. Oxford, UK.
University of Oxford. Pandemic Sciences Institute. Oxford, UK.
University of Oxford. Pandemic Sciences Institute. Oxford, UK.
Nepal Mediciti Hospital. Lalitpur, Nepal.
Universitas Indonesia. Department of Pulmonology and Respiratory Medicine. Infection Division. Depok, Indonesia.
Columbia University Vagelos College of Physicians and Surgeons. Department of Medicine. Division of Pulmonary, Allergy, and Critical Care Medicine. New York, NY, USA.
INSERM. IAME. Paris, France.
Clinica Las Condes. Intensive Care Unit. Santiago, Chile.
Instituto de Infectologia Emílio Ribas. São Paulo, SP, Brasil.
Critical Care Asia and Ziauddin University. Karachi, Pakistan.
All India Institute of Medical Sciences. Rishikesh, India.
Hospital 12 de Octubre. Madrid, Spain.
Fundación Valle del Lili. Department of Intensive Care. Cali, Colombia.
University of Cape Town and Groote Schuur Hospital. Division of Critical Care. Cape Town, South Africa.
University College Dublin Clinical Research Centre at St Vincent's University Hospital. Dublin, Ireland.
St Michael's Hospital. Unity Health Toronto. Li Ka Shing Knowledge Institute. Toronto, ON, Canada.
University of Oxford. Pandemic Sciences Institute. Oxford, UK.
University of British Columbia. Department of Pediatrics. Vancouver, Canada.
Universidad de La Sabana. Infectious Diseases Department. Chía, Colombia.
University of Oxford. Pandemic Sciences Institute. Oxford, UK.
Universidad de La Sabana. Infectious Diseases Department. Chía, Colombia / Clínica Universidad de La Sabana. Critical Care Department. Chía, Colombia.
Vall d'Hebron Institute of Research. Clinical Research Epidemiology in Pneumonia & Sepsis. Barcelona, Spain / Instituto de Salud Carlos III. Centro de Investigación Biomédica En Red de Enfermedades Respiratorias. Madrid, Spain.
Universidad de La Sabana. Infectious Diseases Department. Chía, Colombia / Clínica Universidad de La Sabana. Critical Care Department. Chía, Colombia.
Multidisciplinary Intensive Care Research Organization. Department of Clinical Medicine, St James's Hospital. Dublin, Ireland.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Brazilian Research in Intensive Care Network. Rio de Janeiro, RJ, Brazil.
Universidad de La Sabana. Infectious Diseases Department. Chía, Colombia.
Université Libre de Bruxelles. Department of Intensive Care. Brussels, Belgium / Hôpital Erasme. Department of Intensive Care. Laboratoire de Recherche Experimentale. Brussels, Belgium.
University of Toronto. Interdepartmental Division of Critical Care Medicine. Toronto, ON, Canada.
University of Oxford. Pandemic Sciences Institute. Oxford, UK.
University of Oxford. Pandemic Sciences Institute. Oxford, UK.
University of Oxford. Pandemic Sciences Institute. Oxford, UK.
Nepal Mediciti Hospital. Lalitpur, Nepal.
Universitas Indonesia. Department of Pulmonology and Respiratory Medicine. Infection Division. Depok, Indonesia.
Columbia University Vagelos College of Physicians and Surgeons. Department of Medicine. Division of Pulmonary, Allergy, and Critical Care Medicine. New York, NY, USA.
INSERM. IAME. Paris, France.
Clinica Las Condes. Intensive Care Unit. Santiago, Chile.
Instituto de Infectologia Emílio Ribas. São Paulo, SP, Brasil.
Critical Care Asia and Ziauddin University. Karachi, Pakistan.
All India Institute of Medical Sciences. Rishikesh, India.
Hospital 12 de Octubre. Madrid, Spain.
Fundación Valle del Lili. Department of Intensive Care. Cali, Colombia.
University of Cape Town and Groote Schuur Hospital. Division of Critical Care. Cape Town, South Africa.
University College Dublin Clinical Research Centre at St Vincent's University Hospital. Dublin, Ireland.
St Michael's Hospital. Unity Health Toronto. Li Ka Shing Knowledge Institute. Toronto, ON, Canada.
University of Oxford. Pandemic Sciences Institute. Oxford, UK.
Resumo em Inglês
Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs).
Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support.
Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]).
Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable.
Palavras-chave em inglês
COVID-19Critical care
High flow nasal cannula
Invasive mechanical ventilation
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