Role of non-invasive respiratory supports in COVID-19 acute respiratory failure patients with do not intubate orders

Medrinal, Clément (UVSQ, Erphan, Paris-Saclay University, Versailles, France; Intensive Care Unit Department, Le Havre Hospital, Montivilliers, France; Saint Michel School of Physiotherapy, Paris-Saclay University, Paris, France) ; Gillet, Alexis (Department of Physiotherapy, Erasme University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium) ; Boujibar, Fairuz (Inserm U1096, Rouen University Hospital, Rouen, France; Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France) ; Dugernier, Jonathan (Physiotherapy Unit, RHNe Réseau Hospitalier Neuchâtelois, Pourtalès Hospital, Neuchatel, Switzerland) ; Zwahlen, Marcel (Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland) ; Lamia, Bouchra (Institute for Research and Innovation in Biomedicine (IRIB), Normandie Univ, UNIROUEN, Rouen, France; Pulmonology Department, Le Havre Hospital, Montivilliers, France; Pulmonology, Respiratory Department, Rouen University Hospital, Rouen, France) ; Girault, Christophe (Institute for Research and Innovation in Biomedicine (IRIB), Normandie Univ, UNIROUEN, Rouen, France; Intensive Care Unit Department, Rouen University Hospital, Rouen, France) ; Creteur, Jacques (Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium) ; Fellrath, Jean-Marc (Pulmonary Medicine Unit, RHNe Réseau Hospitalier Neuchâtelois, Pourtalès Hospital, Neuchatel, Switzerland) ; Haesler, Laurence (Institute for Research and Innovation in Biomedicine (IRIB), Normandie Univ, UNIROUEN, Rouen, France; Intensive Care Unit, RHNe Réseau Hospitalier Neuchâtelois, Pourtalès Hospital, Neuchatel, Switzerland) ; Lagache, Laurie (Intensive Care Unit Department, Le Havre Hospital, Montivilliers, France) ; Goubert, Laure (Pulmonology Department, Le Havre Hospital, Montivilliers, France) ; Artaud Macari, Elise (Institute for Research and Innovation in Biomedicine (IRIB), Normandie Univ, UNIROUEN, Rouen, France; Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France) ; Taton, Olivier (Department of Pneumology, Erasme University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium) ; Gouin, Philippe (Intensive Care Unit Department, Rouen University Hospital, Rouen, France) ; Leduc, Dimitri (Department of Pneumology, Erasme University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium) ; Van Hove, Olivier (Department of Physiotherapy, Erasme University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium; Department of Pneumology, Erasme University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium) ; Norrenberg, Michelle (Department of Physiotherapy, Erasme University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium; Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium) ; Prieur, Guillaume (Institute for Research and Innovation in Biomedicine (IRIB), Normandie Univ, UNIROUEN, Rouen, France; Pulmonology Department, Le Havre Hospital, Montivilliers, France; Research and Clinical Experimentation Institute (IREC), Pulmonology, ORL and Dermatology, Louvain Catholic University, Brussels, Belgium) ; Combret, Yann (Institute for Research and Innovation in Biomedicine (IRIB), Normandie Univ, UNIROUEN, Rouen, France; Pulmonology Department, Le Havre Hospital, Montivilliers, France) ; Correvon, Nils (Physiotherapy Unit, RHNe Réseau Hospitalier Neuchâtelois, Pourtalès Hospital, Neuchatel, Switzerland; HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland) ; Hilfiker, Roger (School of Health Sciences, HES-SO Valais-Wallis, Leukerbad, Switzerland) ; Contal, Olivier (HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland)

The current gold-standard treatment for COVID-19-related hypoxemic respiratory failure is invasive mechanical ventilation. However, do not intubate orders (DNI), prevent the use of this treatment in some cases. The aim of this study was to evaluate if non-invasive ventilatory supports can provide a good therapeutic alternative to invasive ventilation in patients with severe COVID-19 infection and a DNI. Data were collected from four centres in three European countries. Patients with severe COVID-19 infection were included. We emulated a hypothetical target trial in which outcomes were compared in patients with a DNI order treated exclusively by non-invasive respiratory support with patients who could be intubated if necessary. We set up a propensity score and an inverse probability of treatment weighting to remove confounding by indication. Four-hundred patients were included: 270 were eligible for intubation and 130 had a DNI order. The adjusted risk ratio for death among patients eligible for intubation was 0.81 (95% CI 0.46 to 1.42). The median length of stay in acute care for survivors was similar between groups (18 (10–31) vs. (19 (13–23.5); p = 0.76). The use of non-invasive respiratory support is a good compromise for patients with severe COVID-19 and a do not intubate order.


Keywords:
Article Type:
scientifique
Faculty:
Santé
Branch:
Physiothérapie
School:
HEdS-VS
HESAV
Institute:
Institut Santé
Unité de recherche en santé, HESAV
Date:
2021-07
Pagination:
11 p.
Published in:
Journal of clinical medicine
Numeration (vol. no.):
July 2021, vol. 10, no. 13, article 2783
DOI:
ISSN:
2077-0383
Appears in Collection:



 Record created 2021-07-02, last modified 2021-07-05

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