Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)
Conditions
Keywords
Novel coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Acute respiratory distress syndrome, High flow nasal canula oxygen, Non-invasive ventilation, Continuous positive airway pressure
Brief summary
Acute Respiratory Distress Syndrome (ARDS) is the main clinical presentation of SARS-CoV-2 (Covid-19) infected patients admitted in Intensive Care Unit (ICU). During the first phase of the outbreak (between February and May 2020), the use of invasive Mechanical Ventilation (MV) was largely required with 63% of ICU patients intubated in the first 24 hours after admission and up to 80% of patients during the overall ICU stay. Mortality was especially higher when using MV in the first 24 hours. In contrast, the use of non-invasive oxygenation strategies in the first 24 hours was only 19% for High Flow Nasal Cannula oxygen therapy (HFNC) and 6% for Non-Invasive Ventilation (NIV). Several non-invasive oxygenation strategies were proposed in order to delay or avoid MV in ICU patients suffering from Covid-19 ARDS. The use of HFNC became the recommended oxygenation strategy, based in particular on publications prior to the outbreak. The use of NIV or Continuous Positive Airway Pressure (CPAP) combined with HFNC have also been proposed. Although these non-invasive oxygenation strategies seem widely used in the second phase of the outbreak, they have not yet confirmed their clinical impact on MV requirement and patient's outcome. Moreover, no comparison has been made between these different non-invasive oxygenation strategies. The aim of this study is to compare different non-invasive oxygenation strategies (HFNC, NIV, CPAP) on MV requirement and outcome in ICU patients treated for ARDS related to Covid-19.
Detailed description
Retrospective multicenter observational registry in French intensive care unit including all consecutive patients admitted for acute respiratory distress syndrome related to SARS-CoV-2 pneumonia between1st July and 31th December 2020. Patients characteristics, ICU treatments and outcome will be recorded.
Interventions
OTHERUse of High Flow Nasal Cannula alone
Use of high flow nasal cannula oxygen therapy alone
OTHERUse of Non-invasive Ventilation
Use of non-invasive ventilation combined or not with high flow nasal cannula oxygen therapy
OTHERUse of Continuous Positive Airway Pressure
Use of continuous positive airway pressure combined or not with high flow nasal cannula oxygen therapy
Sponsors
Centre Hospitalier Intercommunal de Toulon La Seyne sur Mer
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* patients admitted in intensive care unit because of a SARS-CoV-2 infection confirmed by PCR wherever was collected the analyzed sample * acute respiratory distress syndrome according to Berlin criteria * age superior or equal to 18 years old
Exclusion criteria
* patient opposition to participate in the study * patients under judicial protection measures
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Refractory hypoxemia | Through Intensive Care Unit stay, an average of 15 days | Rate of refractory hypoxemia outcome defined by invasive Mechanical Ventilation (endotracheal intubation) requirement or death of non-intubated patients because of therapeutical limitation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mechanical Ventilation free days | Through Intensive Care Unit stay, up to 1 month | Numbers of days without invasive mechanical ventilation during ICU stay and until ICU discharge |
| Survival at ICU discharge | At the moment of Intensive care unit discharge, up to 1 month | Rate of patients alive at the moment of intensive care unit discharge |
| ICU length of stay | At the moment of Intensive care unit discharge, up to 1 month | Number of days spent in Intensive care unit |
| Complications during ICU stay | Through Intensive Care Unit stay, up to 1 month | Number of complications during intensive care unit stay: pneumothorax, pneumomediastinum |
| Delay between admission and intubation | Through Intensive Care Unit stay, up to 1 month | Period of time (in hours or days) between admission in Intensive Care Unit and intubation requirement with invasive mechanical ventilation. |
Countries
France
Outcome results
None listed