Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID): a national, multicentre, observational cohort study

Type Journal Article Author Michela Botta Author Anissa M. Tsonas Author Janesh Pillay Author Leonoor S. Boers Author Anna Geke Algera Author Lieuwe D. J. Bos Author Dave A. Dongelmans Author Marcus W. Hollmann Author Janneke Horn Author Alexander P. J. Vlaar Author Marcus J. Schultz Author Ary Serpa Neto Author Frederique Paulus Author Jesse P. van Akkeren Author Anna Geke Algera Author Cheetel K. Algoe Author Rombout B. van Amstel Author Onno L. Baur Author Pablo van de Berg Author Alida E. van den Berg Author Dennis C. J. J. Bergmans Author Dido I. van den Bersselaar Author Freke A. Bertens Author Alexander J. G. H. Bindels Author Milou M. de Boer Author Sylvia den Boer Author Leonoor S. Boers Author Margriet Bogerd Author Lieuwe D. J. Bos Author Michela Botta Author Jennifer S. Breel Author Hendrik de Bruin Author Sanne de Bruin Author Caro L. Bruna Author Laura A. Buiteman-Kruizinga Author Olaf L. Cremer Author Rogier M. Determann Author Willem Dieperink Author Dave A. Dongelmans Author Hildegard S. Franke Author Michal S. Galek-Aldridge Author Mart J. de Graaff Author Laura A. Hagens Author Jasper J. Haringman Author Sebastiaan T. van der Heide Author Pim L. J. van der Heiden Author Nanon F. L. Heijnen Author Stephan J. P. Hiel Author Lotte L. Hoeijmakers Author Liselotte Hol Author Markus W. Hollmann Author Marga E. Hoogendoorn Author Janneke Horn Author Robrecht van der Horst Author Evy L. K. Ie Author Dimitri P. Ivanov Author Nicole Juffermans Author Eline Kho Author Eline S. de Klerk Author Ankie W. M. M. Koopman-van Gemert Author Matty Koopmans Author Songul Kucukcelebi Author Michael A. Kuiper Author Dylan W. de Lange Author Niels van Mourik Author Sunny G. L. H. Nijbroek Author Marisa Onrust Author Evelien A. N. Oostdijk Author Frederique Paulus Author Charlotte J. Pennartz Author Janesh Pillay Author Luigi Pisani Author Ilse M. Purmer Author Thijs C. D. Rettig Author Jan-Paul Roozeman Author Michiel T. U. Schuijt Author Marcus J. Schultz Author Ary Serpa Neto Author Mengalvio E. Sleeswijk Author Marry R. Smit Author Peter E. Spronk Author Willemke Stilma Author Aart C. Strang Author Anissa M. Tsonas Author Pieter R. Tuinman Author Christel M. A. Valk Author Felicia L. Veen-Schra Author Lars I. Veldhuis Author Patricia van Velzen Author Ward H. van der Ven Author Alexander P. J. Vlaar Author Peter van Vliet Author Peter H. J. van der Voort Author Louis van Welie Author Henrico J. F. T. Wesselink Author Hermien H. van der Wier-Lubbers Author Bas van Wijk Author Tineke Winters Author Wing Yi Wong Author Arthur R. H. van Zanten URL https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30459-8/abstract Publication The Lancet Respiratory Medicine ISSN 2213-2600, 2213-2619 Date 23/10/2020 Extra Publisher: Elsevier Journal Abbr The Lancet Respiratory Medicine DOI 10.1016/S2213-2600(20)30459-8 Library Catalog www.thelancet.com Language English Abstract Background Little is known about the practice of ventilation management in patients with COVID-19. We aimed to describe the practice of ventilation management and to establish outcomes in invasively ventilated patients with COVID-19 in a single country during the first month of the outbreak. Methods PRoVENT-COVID is a national, multicentre, retrospective observational study done at 18 intensive care units (ICUs) in the Netherlands. Consecutive patients aged at least 18 years were eligible for participation if they had received invasive ventilation for COVID-19 at a participating ICU during the first month of the national outbreak in the Netherlands. The primary outcome was a combination of ventilator variables and parameters over the first 4 calendar days of ventilation: tidal volume, positive end-expiratory pressure (PEEP), respiratory system compliance, and driving pressure. Secondary outcomes included the use of adjunctive treatments for refractory hypoxaemia and ICU complications. Patient-centred outcomes were ventilator-free days at day 28, duration of ventilation, duration of ICU and hospital stay, and mortality. PRoVENT-COVID is registered at ClinicalTrials.gov (NCT04346342). Findings Between March 1 and April 1, 2020, 553 patients were included in the study. Median tidal volume was 6·3 mL/kg predicted bodyweight (IQR 5·7–7·1), PEEP was 14·0 cm H2O (IQR 11·0–15·0), and driving pressure was 14·0 cm H2O (11·2–16·0). Median respiratory system compliance was 31·9 mL/cm H2O (26·0–39·9). Of the adjunctive treatments for refractory hypoxaemia, prone positioning was most often used in the first 4 days of ventilation (283 [53%] of 530 patients). The median number of ventilator-free days at day 28 was 0 (IQR 0–15); 186 (35%) of 530 patients had died by day 28. Predictors of 28-day mortality were gender, age, tidal volume, respiratory system compliance, arterial pH, and heart rate on the first day of invasive ventilation. Interpretation In patients with COVID-19 who were invasively ventilated during the first month of the outbreak in the Netherlands, lung-protective ventilation with low tidal volume and low driving pressure was broadly applied and prone positioning was often used. The applied PEEP varied widely, despite an invariably low respiratory system compliance. The findings of this national study provide a basis for new hypotheses and sample size calculations for future trials of invasive ventilation for COVID-19. These data could also help in the interpretation of findings from other studies of ventilation practice and outcomes in invasively ventilated patients with COVID-19. Short Title Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID)