Association of Time–Varying Intensity of Ventilation With Mortality in Patients With COVID−19 ARDS: Secondary Analysis of the PRoVENT–COVID Study

Background: High intensity of ventilation has an association with mortality in patients with acute respiratory failure. It is uncertain whether similar associations exist in patients with acute respiratory distress syndrome (ARDS) patients due to coronavirus disease 2019 (COVID−19). We investigated...

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Autores principales:	Michiel T. U. Schuijt, David M. P. van Meenen, Ignacio Martin–Loeches, Guido Mazzinari, Marcus J. Schultz, Frederique Paulus, Ary Serpa Neto
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	coronavirus disease 2019 acute respiratory distress syndrome driving pressure mechanical power mortality Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/233559dbe67f4077a4e1fd21b49c0814
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spelling	oai:doaj.org-article:233559dbe67f4077a4e1fd21b49c08142021-11-18T09:34:14ZAssociation of Time–Varying Intensity of Ventilation With Mortality in Patients With COVID−19 ARDS: Secondary Analysis of the PRoVENT–COVID Study2296-858X10.3389/fmed.2021.725265https://doaj.org/article/233559dbe67f4077a4e1fd21b49c08142021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.725265/fullhttps://doaj.org/toc/2296-858XBackground: High intensity of ventilation has an association with mortality in patients with acute respiratory failure. It is uncertain whether similar associations exist in patients with acute respiratory distress syndrome (ARDS) patients due to coronavirus disease 2019 (COVID−19). We investigated the association of exposure to different levels of driving pressure (ΔP) and mechanical power (MP) with mortality in these patients.Methods: PRoVENT–COVID is a national, retrospective observational study, performed at 22 ICUs in the Netherlands, including COVID−19 patients under invasive ventilation for ARDS. Dynamic ΔP and MP were calculated at fixed time points during the first 4 calendar days of ventilation. The primary endpoint was 28–day mortality. To assess the effects of time–varying exposure, Bayesian joint models adjusted for confounders were used.Results: Of 1,122 patients included in the PRoVENT–COVID study, 734 were eligible for this analysis. In the first 28 days, 29.2% of patients died. A significant increase in the hazard of death was found to be associated with each increment in ΔP (HR 1.04, 95% CrI 1.01–1.07) and in MP (HR 1.12, 95% CrI 1.01–1.36). In sensitivity analyses, cumulative exposure to higher levels of ΔP or MP resulted in increased risks for 28–day mortality.Conclusion: Cumulative exposure to higher intensities of ventilation in COVID−19 patients with ARDS have an association with increased risk of 28–day mortality. Limiting exposure to high ΔP or MP has the potential to improve survival in these patients.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04346342.Michiel T. U. SchuijtDavid M. P. van MeenenIgnacio Martin–LoechesGuido MazzinariMarcus J. SchultzMarcus J. SchultzMarcus J. SchultzFrederique PaulusFrederique PaulusAry Serpa NetoAry Serpa NetoAry Serpa NetoAry Serpa NetoAry Serpa NetoAry Serpa NetoFrontiers Media S.A.articlecoronavirus disease 2019acute respiratory distress syndromedriving pressuremechanical powermortalityMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	coronavirus disease 2019 acute respiratory distress syndrome driving pressure mechanical power mortality Medicine (General) R5-920
spellingShingle	coronavirus disease 2019 acute respiratory distress syndrome driving pressure mechanical power mortality Medicine (General) R5-920 Michiel T. U. Schuijt David M. P. van Meenen Ignacio Martin–Loeches Guido Mazzinari Marcus J. Schultz Marcus J. Schultz Marcus J. Schultz Frederique Paulus Frederique Paulus Ary Serpa Neto Ary Serpa Neto Ary Serpa Neto Ary Serpa Neto Ary Serpa Neto Ary Serpa Neto Association of Time–Varying Intensity of Ventilation With Mortality in Patients With COVID−19 ARDS: Secondary Analysis of the PRoVENT–COVID Study
description	Background: High intensity of ventilation has an association with mortality in patients with acute respiratory failure. It is uncertain whether similar associations exist in patients with acute respiratory distress syndrome (ARDS) patients due to coronavirus disease 2019 (COVID−19). We investigated the association of exposure to different levels of driving pressure (ΔP) and mechanical power (MP) with mortality in these patients.Methods: PRoVENT–COVID is a national, retrospective observational study, performed at 22 ICUs in the Netherlands, including COVID−19 patients under invasive ventilation for ARDS. Dynamic ΔP and MP were calculated at fixed time points during the first 4 calendar days of ventilation. The primary endpoint was 28–day mortality. To assess the effects of time–varying exposure, Bayesian joint models adjusted for confounders were used.Results: Of 1,122 patients included in the PRoVENT–COVID study, 734 were eligible for this analysis. In the first 28 days, 29.2% of patients died. A significant increase in the hazard of death was found to be associated with each increment in ΔP (HR 1.04, 95% CrI 1.01–1.07) and in MP (HR 1.12, 95% CrI 1.01–1.36). In sensitivity analyses, cumulative exposure to higher levels of ΔP or MP resulted in increased risks for 28–day mortality.Conclusion: Cumulative exposure to higher intensities of ventilation in COVID−19 patients with ARDS have an association with increased risk of 28–day mortality. Limiting exposure to high ΔP or MP has the potential to improve survival in these patients.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04346342.
format	article
author	Michiel T. U. Schuijt David M. P. van Meenen Ignacio Martin–Loeches Guido Mazzinari Marcus J. Schultz Marcus J. Schultz Marcus J. Schultz Frederique Paulus Frederique Paulus Ary Serpa Neto Ary Serpa Neto Ary Serpa Neto Ary Serpa Neto Ary Serpa Neto Ary Serpa Neto
author_facet	Michiel T. U. Schuijt David M. P. van Meenen Ignacio Martin–Loeches Guido Mazzinari Marcus J. Schultz Marcus J. Schultz Marcus J. Schultz Frederique Paulus Frederique Paulus Ary Serpa Neto Ary Serpa Neto Ary Serpa Neto Ary Serpa Neto Ary Serpa Neto Ary Serpa Neto
author_sort	Michiel T. U. Schuijt
title	Association of Time–Varying Intensity of Ventilation With Mortality in Patients With COVID−19 ARDS: Secondary Analysis of the PRoVENT–COVID Study
title_short	Association of Time–Varying Intensity of Ventilation With Mortality in Patients With COVID−19 ARDS: Secondary Analysis of the PRoVENT–COVID Study
title_full	Association of Time–Varying Intensity of Ventilation With Mortality in Patients With COVID−19 ARDS: Secondary Analysis of the PRoVENT–COVID Study
title_fullStr	Association of Time–Varying Intensity of Ventilation With Mortality in Patients With COVID−19 ARDS: Secondary Analysis of the PRoVENT–COVID Study
title_full_unstemmed	Association of Time–Varying Intensity of Ventilation With Mortality in Patients With COVID−19 ARDS: Secondary Analysis of the PRoVENT–COVID Study
title_sort	association of time–varying intensity of ventilation with mortality in patients with covid−19 ards: secondary analysis of the provent–covid study
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/233559dbe67f4077a4e1fd21b49c0814
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Association of Time–Varying Intensity of Ventilation With Mortality in Patients With COVID−19 ARDS: Secondary Analysis of the PRoVENT–COVID Study

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