Impact of ventilatory support modalities and timing of intubation on longitudinal recovery of pulmonary sequelae in critically ill Covid-19 patients

<bold>Purpose:</bold> The impact of the different ventilatory support modalities and the timing of intubation on longitudinal lung recovery trajectories in patients with severe COVID-19 is unknown. <bold>Methods:</bold> Multicenter, prospective observational study in 52 Spanish intensive care units (ICUs). A total of 1854 COVID-19 patients were followed after hospital discharge at 3, 6 and 12 months with D<sub>LCO</sub> and a chest imaging were included. Patients were classified regarding the ventilatory support received during the ICU stay: noninvasive mechanical ventilation (NIMV), high-flow nasal cannula (HFNC) and invasive mechanical ventilation (IMV). The latter was divided into early IMV (intubation within the first 24 hours) and delayed IMV (intubation >24 hours). <bold>Results:</bold> A total of 360 (19.4%) and 290 (15.6%) patients received HFNC and NIMV, respectively. A total of 1204 (64.9%) patients underwent IMV; 996 were classified into the early IMV group, and 238 into the delayed IMV group. The latter exhibited significantly the worse D<sub>LCO</sub> during the one-year follow-up. With respect to the noninvasive groups, patients under NIMV exhibited slower D<sub>LCO</sub> recovery than those under HFNC, as well as more radiological abnormalities during the follow-up period. A sensitivity analysis using propensity scores was performed and confirmed these results. <bold>Conclusions:</bold> Lung recovery trajectories differ with respect to the respiratory support received during patients’ ICU stays. The delay in intubation implies the worst outcomes; however, patients with NIMV exhibited worse D<sub>LCO</sub> measurements, more radiological abnormalities and a slower recovery compared with patients with HFNC.

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Published
2024-09-14
DOI
https://doi.org/10.1183/13993003.congress-2024.oa5566
Primary Topic
Respiratory Support and Mechanisms
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article
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article

Impact of ventilatory support modalities and timing of intubation on longitudinal recovery of pulmonary sequelae in critically ill Covid-19 patients

Jordi Riera, Jordi de Batlle, Berta Adell-Serrano, Luciano Aguilera et al.
Respiratory Support and Mechanisms
article

Impact of ventilatory support modalities and timing of intubation on longitudinal recovery of pulmonary sequelae in critically ill Covid-19 patients

Jordi Riera, Jordi de Batlle, Berta Adell-Serrano, Luciano Aguilera, Felipe Pérez‐García, Esther Gràcia‐Lavedan, M.C. Martín Delgado, Pilar Ricart, Gerard Torres, Mariana Andrea Novo, Ricard Ferrer, Ferran Roche‐Campo, Adrián Ceccato, Yhivian Peñasco, Maria Victoria Boado Varela, Jessica González Gutiérrez, D. García, Ferrán Barbé, Oriol Roca, Rosario Menéndez, Sally Santisteve, José Barberán, Jordi Solé‐Violán, Iván D. Benítez, Rosario Amaya Villar, Laia Fernández‐Barat, Alejandro Rodrı́guez, Ana Motos, Juan Carlos Pozo‐Laderas, José Ángel Lorente, David de Gonzalo-Calvo, Óscar Peñuelas, Clara Gort-Paniello, Maria Aguilà, Anna Moncusí-Moix, Antoni Torres
article en

Abstract

<bold>Purpose:</bold> The impact of the different ventilatory support modalities and the timing of intubation on longitudinal lung recovery trajectories in patients with severe COVID-19 is unknown. <bold>Methods:</bold> Multicenter, prospective observational study in 52 Spanish intensive care units (ICUs). A total of 1854 COVID-19 patients were followed after hospital discharge at 3, 6 and 12 months with D<sub>LCO</sub> and a chest imaging were included. Patients were classified regarding the ventilatory support received during the ICU stay: noninvasive mechanical ventilation (NIMV), high-flow nasal cannula (HFNC) and invasive mechanical ventilation (IMV). The latter was divided into early IMV (intubation within the first 24 hours) and delayed IMV (intubation >24 hours). <bold>Results:</bold> A total of 360 (19.4%) and 290 (15.6%) patients received HFNC and NIMV, respectively. A total of 1204 (64.9%) patients underwent IMV; 996 were classified into the early IMV group, and 238 into the delayed IMV group. The latter exhibited significantly the worse D<sub>LCO</sub> during the one-year follow-up. With respect to the noninvasive groups, patients under NIMV exhibited slower D<sub>LCO</sub> recovery than those under HFNC, as well as more radiological abnormalities during the follow-up period. A sensitivity analysis using propensity scores was performed and confirmed these results. <bold>Conclusions:</bold> Lung recovery trajectories differ with respect to the respiratory support received during patients’ ICU stays. The delay in intubation implies the worst outcomes; however, patients with NIMV exhibited worse D<sub>LCO</sub> measurements, more radiological abnormalities and a slower recovery compared with patients with HFNC.

Universidad San Pablo CEU (ES), Universidad de Alcalá (ES), Barcelona Supercomputing Center (ES), Instituto de Salud Carlos III (ES), Hospital Universitari Arnau de Vilanova (ES), Hospital Universitario de Torrejón (ES), Universidad Fernando Pessoa Canarias (ES), Hospital de Basurto (ES), Instituto Maimónides de Investigación Biomédica de Córdoba (ES), Hospital Universitario de Gran Canaria Doctor Negrín (ES), Marqués de Valdecilla University Hospital (ES), Vall d'Hebron Institut de Recerca (ES), Hospital Universitario Príncipe de Asturias (ES), Corporació Sanitària Parc Taulí (ES), Hospital Universitario Reina Sofía (ES), Institute of Research and Innovation Parc Tauli (ES), Hospital de Cruces (ES), Hospital Universitari Joan XXIII de Tarragona (ES), Hospital Universitari de Tortosa Verge de la Cinta (ES), Hospital Universitario Son Espases (ES), Hospital Universitario Virgen del Rocío (ES), Hospital Universitari Germans Trias i Pujol (ES), Universitat Politècnica de Catalunya (ES)
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Respiratory Support and Mechanisms
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