Evidence map›Paper›PMID 34034782›Full record

ArticleCritical care (London, England)2021

Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort.

Pedro D Wendel Garcia, Hernán Aguirre-Bermeo, Philipp K Buehler, Mario Alfaro-Farias, Bernd Yuen, Sascha David, Thomas Tschoellitsch, Tobias Wengenmayer, Anita Korsos, Alberto Fogagnolo and 55 more

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Article in Critical care (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
37citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

37 citing papers in PubMed, 6 syntheses or guidelines pooled it.

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  20. Effectiveness of high-flow nasal cannula therapy on clinical outcomes in adults with COVID-19: A systematic review.Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR · 2023
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

65 authors.

Pedro D Wendel GarciaInstitute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.
Hernán Aguirre-BermeoUnidad de Cuidados Intensivos, Hospital Vicente Corral Moscoso, Cuenca, Ecuador.
Philipp K BuehlerInstitute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.
Mario Alfaro-FariasUnidad de Cuidados Intensivos, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra.
Bernd YuenInterdisziplinaere Intensivstation, Spital Buelach, Buelach, Switzerland.
Sascha DavidDepartment of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany.
Thomas TschoellitschDepartment of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH and Johannes Kepler University, Linz, Austria.
Tobias WengenmayerDepartment of Medicine III - Interdisciplinary Medical Intensive Care, Medical Center University of Freiburg, Freiburg, Germany.
Anita KorsosDepartement of Anaethesiology and Intensive Care, University of Szeged, Szeged, Hungary.
Alberto FogagnoloAnesthesia and Intensive Care, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy.
Gian-Reto KlegerMedizinische Intensivstation, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Maddalena A WuDepartment of Internal Medicine, ASST Fatebenefratelli Sacco - "Luigi Sacco" Hospital, Milan, Italy.
Riccardo ColomboDivision of Anesthesia and Intensive Care, ASST Fatebenefratelli Sacco - "Luigi Sacco" Hospital, Milan, Italy.
Fabrizio TurriniInternal Medicine, Azienda Ospedaliera Universitaria di Modena, Modena, Italy.
Antonella PotalivoUOC Anestesia e Rianimazione, Ospedale Infermi, Rimini, Italy.
Emanuele RezoagliDepartment of Anesthesia and Intensive Care Medicine, Policlinico San Marco, Gruppo Ospedaliero San Donato, Bergamo, Italy.
Raquel Rodríguez-GarcíaServicio de Medicina intensiva, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Pedro CastroMedical Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain.
Arantxa Lander-AzconaServicio de Medicina Intensiva, Hospital General San Jorge, Huesca, Spain.
Maria C Martín-DelgadoServicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid, Spain.
Herminia Lozano-GómezUnidad de Cuidados Intensivos, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
Rolf EnsnerKlinik für Operative Intensivmedizin, Kantonsspital Aarau, Aarau, Switzerland.
Marc P MichotMedizinische Intensivstation, Kantonsspital Aarau, Aarau, Switzerland.
Nadine GehringIntensivstation, Kantonsspital Schaffhausen, Schaffhausen, Switzerland.
Peter SchottInstitut fuer Anesthaesie und Intensivmedizin, Zuger Kantonsspital AG, Baar, Switzerland.
Martin SiegemundDepartment Intensivmedizin, Universitaetsspital Basel, Basel, Switzerland.
Lukas MerkiIntensivmedizin, St. Claraspital, Basel, Switzerland.
Jan WiegandInterdisziplinaere Intensivmedizin, Lindenhofspital, Bern, Switzerland.
Marie M JeitzinerDepartment of Intensive Care Medicine, University Hospital Bern, Inselspital, Bern, Switzerland.
Marcus LaubeDepartment Intensive Care Medicine, Spitalzentrum Biel, Biel, Switzerland.
Petra SalomonIntensivstation, Regionalspital Emmental AG, Burgdorf, Switzerland.
Frank HillgaertnerIntensivmedizin, Kantonsspital Graubuenden, Chur, Switzerland.
Alexander DullenkopfInstitut fuer Anaesthesie und Intensivmedizin, Spital Thurgau, Frauenfeld, Switzerland.
Hatem KsouriSoins Intensifs, Hopital cantonal de Fribourg, Fribourg, Switzerland.
Sara CereghettiDivision of Intensive Care, University Hospitals of Geneva, Geneva, Switzerland.
Serge GrazioliDivision of Neonatal and Pediatric Intensive Care, University Hospitals of Geneva, Geneva, Switzerland.
Christian BürkleIntensivstation, Spital Grabs, Grabs, Switzerland.
Julien MarrelInstitut für Anaesthesiologie Intensivmedizin & Rettungsmedizin, See-Spital Horgen & Kilchberg, Horgen, Switzerland.
Isabelle FleischSoins Intensifs, Hirslanden Clinique Cecil, Lausanne, Switzerland.
Marie-Helene PerezPediatric Intensive Care Unit, University Hospital Lausanne, Lausanne, Switzerland.
Anja Baltussen WeberAnaesthesie und Intensivmedizin, Kantonsspital Baselland, Liestal, Switzerland.
Samuele CerutiDipartimento Area Critica, Clinica Luganese Moncucco, Lugano, Switzerland.
Katharina MarquardtInterdisziplinaere Intensivstation, Spital Maennedorf AG, Maennedorf, Switzerland.
Tobias HübnerInstitut fuer Anaesthesie und Intensivmedizin, Spital Thurgau, Muensterlingen, Switzerland.
Hermann RedeckerIntensivmedizin, Schweizer Paraplegikerzentrum Nottwil, Nottwil, Switzerland.
Michael StudhalterIntensivmedizin & Intermediate Care, Kantonsspital Olten, Olten, Switzerland.
Michael StephanIntensivmedizin, Spital Oberengadin, Samedan, Switzerland.
Daniela SelzAnaesthesie Intensivmedizin Schmerzmedizin, Spital Schwyz, Schwyz, Switzerland.
Urs PietschDepartement of Anesthesiology and Intensive Care Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Anette RisticDepartement for Intensive Care Medicine, Kantonsspital Nidwalden, Stans, Switzerland.
Antje HeiseIntensivstation, Spital Simmental-Thun-Saanenland AG, Thun, Switzerland.
Friederike Meyer Zu BentrupKlinik für Anaesthesie und Intensivmedizin, Spitalzentrum Oberwallis, Visp, Switzerland.
Marilene Franchitti LaurentService d'Anesthesiologie, EHNV, Yverdon-les-Bains, Switzerland.
Patricia FodorInterdisziplinaere Intensivstation, Stadtspital Triemli, Zurich, Switzerland.
Tomislav GaspertAbteilung für Anaesthesiologie und Intensivmedizin, Hirslanden Klinik Im Park, Zurich, Switzerland.
Christoph HaberthuerInstitut für Anaesthesiologie und Intensivmedizin, Klinik Hirslanden, Zurich, Switzerland.
Elif ColakGeneral Surgery, Samsun Training and Research Hospital, Samsun, Turkey.
Dorothea M HeubergerInstitute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.
Thierry FumeauxThe RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland.
Jonathan MontomoliThe RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland.
Philippe GuerciThe RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland.
Reto A SchuepbachInstitute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.
Matthias P HiltyInstitute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.
Ferran Roche-CampoServicio de Medicina intensiva, Hospital Verge de la Cinta, Carrer de les Esplanetes 44, 43500, Tortosa, Tarragona, Spain. ferranroche@gmail.com.ORCID 0000-0002-4330-1706
RISC-19-ICU Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundUncertainty about the optimal respiratory support strategies in critically ill COVID-19 patients is widespread. While the risks and benefits of noninvasive techniques versus early invasive mechanical ventilation (IMV) are intensely debated, actual evidence is lacking. We sought to assess the risks and benefits of different respiratory support strategies, employed in intensive care units during the first months of the COVID-19 pandemic on intubation and intensive care unit (ICU) mortality rates.

methodsSubanalysis of a prospective, multinational registry of critically ill COVID-19 patients. Patients were subclassified into standard oxygen therapy ≥10 L/min (SOT), high-flow oxygen therapy (HFNC), noninvasive positive-pressure ventilation (NIV), and early IMV, according to the respiratory support strategy employed at the day of admission to ICU. Propensity score matching was performed to ensure comparability between groups.

resultsInitially, 1421 patients were assessed for possible study inclusion. Of these, 351 patients (85 SOT, 87 HFNC, 87 NIV, and 92 IMV) remained eligible for full analysis after propensity score matching. 55% of patients initially receiving noninvasive respiratory support required IMV. The intubation rate was lower in patients initially ventilated with HFNC and NIV compared to those who received SOT (SOT: 64%, HFNC: 52%, NIV: 49%, p = 0.025). Compared to the other respiratory support strategies, NIV was associated with a higher overall ICU mortality (SOT: 18%, HFNC: 20%, NIV: 37%, IMV: 25%, p = 0.016).

conclusionIn this cohort of critically ill patients with COVID-19, a trial of HFNC appeared to be the most balanced initial respiratory support strategy, given the reduced intubation rate and comparable ICU mortality rate. Nonetheless, considering the uncertainty and stress associated with the COVID-19 pandemic, SOT and early IMV represented safe initial respiratory support strategies. The presented findings, in agreement with classic ARDS literature, suggest that NIV should be avoided whenever possible due to the elevated ICU mortality risk.

Indexed as

AgedCOVID-19Critical IllnessDisease ProgressionFemaleHospital MortalityHumansIntensive Care UnitsMaleMiddle AgedProspective StudiesRegistriesRespiratory TherapyRetrospective StudiesTime FactorsTreatment OutcomeARDSCOVID-19High flow oxygen therapyInvasive mechanical ventilationNoninvasive mechanical ventilationPatient self-inflicted lung injuryRespiratory supportStandard oxygen therapy

Identifiers

PMID34034782
PMCPMC8146172

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.