Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic

Kamil Polok; Jakub Fronczek; Bertrand Guidet; Antonio Artigas; Dylan W De Lange; Jesper Fjølner; Susannah Leaver; Michael Beil; Sigal Sviri; Raphael Romano Bruno; Bernhard Wernly; Bernardo Bollen Pinto; Joerg C Schefold; Dorota Studzińska; Michael Joannidis; Sandra Oeyen; Brian Marsh; Finn H Andersen; Rui Moreno; Maurizio Cecconi; Hans Flaatten; Christian Jung; Wojciech Szczeklik; COVIP & VIP2 study groups

doi:10.1186/s13613-023-01173-2

Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic

Kamil Polok, Jakub Fronczek, Bertrand Guidet, Antonio Artigas, Dylan W De Lange, Jesper Fjølner, Susannah Leaver, Michael Beil, Sigal Sviri, Raphael Romano Bruno, Bernhard Wernly, Bernardo Bollen Pinto, Joerg C Schefold, Dorota Studzińska, Michael Joannidis, Sandra Oeyen, Brian Marsh, Finn H Andersen, Rui Moreno, Maurizio CecconiHans Flaatten, Christian Jung, Wojciech Szczeklik^*, COVIP & VIP2 study groups

^*Corresponding author for this work

Department of Clinical Medicine - Operation og Intensiv, Viborg

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

BACKGROUND: Non-invasive ventilation (NIV) has been commonly used to treat acute respiratory failure due to COVID-19. In this study we aimed to compare outcomes of older critically ill patients treated with NIV before and during the COVID-19 pandemic.

METHODS: We analysed a merged cohort of older adults admitted to intensive care units (ICUs) due to respiratory failure. Patients were enrolled into one of two prospective observational studies: before COVID-19 (VIP2-2018 to 2019) and admitted due to COVID-19 (COVIP-March 2020 to January 2023). The outcomes included: 30-day mortality, intubation rate and NIV failure (death or intubation within 30 days).

RESULTS: The final cohort included 1986 patients (1292 from VIP2, 694 from COVIP) with a median age of 83 years. NIV was used as a primary mode of respiratory support in 697 participants (35.1%). ICU admission due to COVID-19 was associated with an increased 30-day mortality (65.5% vs. 36.5%, HR 2.18, 95% CI 1.71 to 2.77), more frequent intubation (36.9% vs. 17.5%, OR 2.63, 95% CI 1.74 to 3.99) and NIV failure (76.2% vs. 45.3%, OR 4.21, 95% CI 2.84 to 6.34) compared to non-COVID causes of respiratory failure. Sensitivity analysis after exclusion of patients in whom life supporting treatment limitation was introduced during primary NIV confirmed higher 30-day mortality in patients with COVID-19 (52.5% vs. 23.4%, HR 2.64, 95% CI 1.83 to 3.80).

CONCLUSION: The outcomes of patients aged ≥80 years treated with NIV during COVID-19 pandemic were worse compared then those treated with NIV in the pre-pandemic era.

Original language	English
Article number	82
Journal	Annals of Intensive Care
Volume	13
Issue	1
Number of pages	10
ISSN	2110-5820
DOIs	https://doi.org/10.1186/s13613-023-01173-2
Publication status	Published - Sept 2023

Keywords

COVID-19
Intensive care unit
Non-invasive ventilation
Older patients
Respiratory failure

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Polok, K., Fronczek, J., Guidet, B., Artigas, A., De Lange, D. W., Fjølner, J., Leaver, S., Beil, M., Sviri, S., Bruno, R. R., Wernly, B., Pinto, B. B., Schefold, J. C., Studzińska, D., Joannidis, M., Oeyen, S., Marsh, B., Andersen, F. H., Moreno, R., ... COVIP & VIP2 study groups (2023). Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic. Annals of Intensive Care, 13(1), Article 82. https://doi.org/10.1186/s13613-023-01173-2

@article{42366d91e8b04d949441a873e401cbcf,

title = "Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic",

abstract = "BACKGROUND: Non-invasive ventilation (NIV) has been commonly used to treat acute respiratory failure due to COVID-19. In this study we aimed to compare outcomes of older critically ill patients treated with NIV before and during the COVID-19 pandemic.METHODS: We analysed a merged cohort of older adults admitted to intensive care units (ICUs) due to respiratory failure. Patients were enrolled into one of two prospective observational studies: before COVID-19 (VIP2-2018 to 2019) and admitted due to COVID-19 (COVIP-March 2020 to January 2023). The outcomes included: 30-day mortality, intubation rate and NIV failure (death or intubation within 30 days).RESULTS: The final cohort included 1986 patients (1292 from VIP2, 694 from COVIP) with a median age of 83 years. NIV was used as a primary mode of respiratory support in 697 participants (35.1%). ICU admission due to COVID-19 was associated with an increased 30-day mortality (65.5% vs. 36.5%, HR 2.18, 95% CI 1.71 to 2.77), more frequent intubation (36.9% vs. 17.5%, OR 2.63, 95% CI 1.74 to 3.99) and NIV failure (76.2% vs. 45.3%, OR 4.21, 95% CI 2.84 to 6.34) compared to non-COVID causes of respiratory failure. Sensitivity analysis after exclusion of patients in whom life supporting treatment limitation was introduced during primary NIV confirmed higher 30-day mortality in patients with COVID-19 (52.5% vs. 23.4%, HR 2.64, 95% CI 1.83 to 3.80).CONCLUSION: The outcomes of patients aged ≥80 years treated with NIV during COVID-19 pandemic were worse compared then those treated with NIV in the pre-pandemic era.",

keywords = "COVID-19, Intensive care unit, Non-invasive ventilation, Older patients, Respiratory failure",

author = "Kamil Polok and Jakub Fronczek and Bertrand Guidet and Antonio Artigas and {De Lange}, {Dylan W} and Jesper Fj{\o}lner and Susannah Leaver and Michael Beil and Sigal Sviri and Bruno, {Raphael Romano} and Bernhard Wernly and Pinto, {Bernardo Bollen} and Schefold, {Joerg C} and Dorota Studzi{\'n}ska and Michael Joannidis and Sandra Oeyen and Brian Marsh and Andersen, {Finn H} and Rui Moreno and Maurizio Cecconi and Hans Flaatten and Christian Jung and Wojciech Szczeklik and {COVIP & VIP2 study groups}",

year = "2023",

month = sep,

doi = "10.1186/s13613-023-01173-2",

language = "English",

volume = "13",

journal = "Annals of Intensive Care",

issn = "2110-5820",

publisher = "SpringerOpen",

number = "1",

}

Polok, K, Fronczek, J, Guidet, B, Artigas, A, De Lange, DW, Fjølner, J, Leaver, S, Beil, M, Sviri, S, Bruno, RR, Wernly, B, Pinto, BB, Schefold, JC, Studzińska, D, Joannidis, M, Oeyen, S, Marsh, B, Andersen, FH, Moreno, R, Cecconi, M, Flaatten, H, Jung, C, Szczeklik, W & COVIP & VIP2 study groups 2023, 'Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic', Annals of Intensive Care, vol. 13, no. 1, 82. https://doi.org/10.1186/s13613-023-01173-2

Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic. / Polok, Kamil; Fronczek, Jakub; Guidet, Bertrand et al.
In: Annals of Intensive Care, Vol. 13, No. 1, 82, 09.2023.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic

AU - Polok, Kamil

AU - Fronczek, Jakub

AU - Guidet, Bertrand

AU - Artigas, Antonio

AU - De Lange, Dylan W

AU - Fjølner, Jesper

AU - Leaver, Susannah

AU - Beil, Michael

AU - Sviri, Sigal

AU - Bruno, Raphael Romano

AU - Wernly, Bernhard

AU - Pinto, Bernardo Bollen

AU - Schefold, Joerg C

AU - Studzińska, Dorota

AU - Joannidis, Michael

AU - Oeyen, Sandra

AU - Marsh, Brian

AU - Andersen, Finn H

AU - Moreno, Rui

AU - Cecconi, Maurizio

AU - Flaatten, Hans

AU - Jung, Christian

AU - Szczeklik, Wojciech

AU - COVIP & VIP2 study groups

PY - 2023/9

Y1 - 2023/9

N2 - BACKGROUND: Non-invasive ventilation (NIV) has been commonly used to treat acute respiratory failure due to COVID-19. In this study we aimed to compare outcomes of older critically ill patients treated with NIV before and during the COVID-19 pandemic.METHODS: We analysed a merged cohort of older adults admitted to intensive care units (ICUs) due to respiratory failure. Patients were enrolled into one of two prospective observational studies: before COVID-19 (VIP2-2018 to 2019) and admitted due to COVID-19 (COVIP-March 2020 to January 2023). The outcomes included: 30-day mortality, intubation rate and NIV failure (death or intubation within 30 days).RESULTS: The final cohort included 1986 patients (1292 from VIP2, 694 from COVIP) with a median age of 83 years. NIV was used as a primary mode of respiratory support in 697 participants (35.1%). ICU admission due to COVID-19 was associated with an increased 30-day mortality (65.5% vs. 36.5%, HR 2.18, 95% CI 1.71 to 2.77), more frequent intubation (36.9% vs. 17.5%, OR 2.63, 95% CI 1.74 to 3.99) and NIV failure (76.2% vs. 45.3%, OR 4.21, 95% CI 2.84 to 6.34) compared to non-COVID causes of respiratory failure. Sensitivity analysis after exclusion of patients in whom life supporting treatment limitation was introduced during primary NIV confirmed higher 30-day mortality in patients with COVID-19 (52.5% vs. 23.4%, HR 2.64, 95% CI 1.83 to 3.80).CONCLUSION: The outcomes of patients aged ≥80 years treated with NIV during COVID-19 pandemic were worse compared then those treated with NIV in the pre-pandemic era.

AB - BACKGROUND: Non-invasive ventilation (NIV) has been commonly used to treat acute respiratory failure due to COVID-19. In this study we aimed to compare outcomes of older critically ill patients treated with NIV before and during the COVID-19 pandemic.METHODS: We analysed a merged cohort of older adults admitted to intensive care units (ICUs) due to respiratory failure. Patients were enrolled into one of two prospective observational studies: before COVID-19 (VIP2-2018 to 2019) and admitted due to COVID-19 (COVIP-March 2020 to January 2023). The outcomes included: 30-day mortality, intubation rate and NIV failure (death or intubation within 30 days).RESULTS: The final cohort included 1986 patients (1292 from VIP2, 694 from COVIP) with a median age of 83 years. NIV was used as a primary mode of respiratory support in 697 participants (35.1%). ICU admission due to COVID-19 was associated with an increased 30-day mortality (65.5% vs. 36.5%, HR 2.18, 95% CI 1.71 to 2.77), more frequent intubation (36.9% vs. 17.5%, OR 2.63, 95% CI 1.74 to 3.99) and NIV failure (76.2% vs. 45.3%, OR 4.21, 95% CI 2.84 to 6.34) compared to non-COVID causes of respiratory failure. Sensitivity analysis after exclusion of patients in whom life supporting treatment limitation was introduced during primary NIV confirmed higher 30-day mortality in patients with COVID-19 (52.5% vs. 23.4%, HR 2.64, 95% CI 1.83 to 3.80).CONCLUSION: The outcomes of patients aged ≥80 years treated with NIV during COVID-19 pandemic were worse compared then those treated with NIV in the pre-pandemic era.

KW - COVID-19

KW - Intensive care unit

KW - Non-invasive ventilation

KW - Older patients

KW - Respiratory failure

UR - http://www.scopus.com/inward/record.url?scp=85170555552&partnerID=8YFLogxK

U2 - 10.1186/s13613-023-01173-2

DO - 10.1186/s13613-023-01173-2

M3 - Journal article

C2 - 37698708

SN - 2110-5820

VL - 13

JO - Annals of Intensive Care

JF - Annals of Intensive Care

IS - 1

M1 - 82

ER -

Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic

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