Association Between Emergency-Authorized Nonconventional Ventilator Use and Mortality Among Patients With COVID-19–Associated ARDS
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVES
Nonconventional ventilators (NCVs), defined here as transport ventilators and certain noninvasive positive pressure devices, were used extensively as crisis-time ventilators for intubated patients with COVID-19. We assessed whether there was an association between the use of NCV and higher mortality, independent of other factors.
DESIGN
This is a multicenter retrospective observational study.
SETTING
The sample was recruited from a single healthcare system in New York. The recruitment period spanned from March 1, 2020, to April 30, 2020.
PATIENTS
The sample includes patients who were intubated for COVID-19 acute respiratory distress syndrome (ARDS).
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
The primary outcome was 28-day in-hospital mortality. Multivariable logistic regression was used to derive the odds of mortality among patients managed exclusively with NCV throughout their ventilation period compared with the remainder of the sample while adjusting for other factors. A secondary analysis was also done, in which the mortality of a subset of the sample exclusively ventilated with NCV was compared with that of a propensity score-matched subset of the control group. Exclusive use of NCV was associated with a higher 28-day in-hospital mortality while adjusting for confounders in the regression analysis (odds ratio, 1.41; 95% CI [1.07-1.86]). In the propensity score matching analysis, the mortality of patients exclusively ventilated with NCV was 68.9%, and that of the control was 60.7% (p = 0.02).
CONCLUSIONS
Use of NCV was associated with increased mortality among patients with COVID-19 ARDS. More lives may be saved during future ventilator shortages if more full-feature ICU ventilators, rather than NCVs, are reserved in national and local stockpiles.
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Additional Info
Should Transport Ventilators Be Used in Times of Crisis? The Use of Emergency Authorized Nonconventional Ventilators Is Associated With Mortality Among Patients With COVID-19 Acute Respiratory Distress Syndrome
Crit. Care Med. 2024 Apr 02;[EPub Ahead of Print], VB Gondhalekar, A Gandomi, SL Gilman, N Hajizadeh, ZM Hasan, MA Bank, DM Rolston, A Cohen, T Li, M Nishikimi, M Narasimhan, L Becker, D JafariFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.