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

Ann Intensive Care. 2023 Sep 12;13(1):82. doi: 10.1186/s13613-023-01173-2.

Authors

Kamil Polok^{1

2}, Jakub Fronczek¹, Bertrand Guidet³, Antonio Artigas⁴, Dylan W De Lange⁵, Jesper Fjølner⁶, Susannah Leaver⁷, Michael Beil⁸, Sigal Sviri⁹, Raphael Romano Bruno¹⁰, Bernhard Wernly^{11

12}, Bernardo Bollen Pinto¹³, Joerg C Schefold¹⁴, Dorota Studzińska¹, Michael Joannidis¹⁵, Sandra Oeyen¹⁶, Brian Marsh¹⁷, Finn H Andersen^{18

19}, Rui Moreno^{20

21}, Maurizio Cecconi^{22

23}, Hans Flaatten^{24

25}, Christian Jung¹⁰, Wojciech Szczeklik²⁶; COVIP & VIP2 study groups

Affiliations

¹ Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30-901, Kraków, Poland.
² Department of Pulmonology, Jagiellonian University Medical College, Kraków, Poland.
³ UMR_S 1136, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, UPMC Univ Paris 06, INSERMInstitut Pierre Louis d'Epidémiologie et de Santé PubliqueAssistance Publique - Hôpitaux de Paris, Sorbonne Universités, F-75012, Paris, France.
⁴ Critical Care Department, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain.
⁵ Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands.
⁶ Department of Anaesthesia and Intensive Care, Viborg Regional Hospital, Viborg, Denmark.
⁷ Department of Critical Care, St George's Hospital, London, UK.
⁸ Medical Intensive Care Unit, Hadassah Medical Center, Jerusalem, Israel.
⁹ Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
¹⁰ Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
¹¹ Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria.
¹² Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria.
¹³ Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland.
¹⁴ Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹⁵ Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria.
¹⁶ Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium.
¹⁷ Mater Misericordiae University Hospital, Dublin, Ireland.
¹⁸ Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.
¹⁹ Department of Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway.
²⁰ Faculdade de Ciências Médicas de Lisboa (Nova Médical School), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
²¹ Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal.
²² Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy.
²³ Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
²⁴ Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
²⁵ Department of Clinical Medicine, University of Bergen, Bergen, Norway.
²⁶ Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30-901, Kraków, Poland. wojciech.szczeklik@uj.edu.pl.

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.