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[Prognostic factors in an individualised approach to non-pharmacological therapy of COVID-19: from oxygen and mechanical ventilation to extracorporeal membrane oxygenation].
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- Author(s): Matthes S;Matthes S;Matthes S; Holl J; Holl J; Randerath J; Randerath J; Treml M; Treml M; Sofianos G; Sofianos G; Bockover M; Bockover M; Oesterlee U; Oesterlee U; Herkenrath S; Herkenrath S; Knoch J; Knoch J; Hagmeyer L; Hagmeyer L; Hagmeyer L; Randerath W; Randerath W; Randerath W
- Source:
Pneumologie (Stuttgart, Germany) [Pneumologie] 2024 Jul; Vol. 78 (7), pp. 515-525. Date of Electronic Publication: 2024 Jan 29.- Publication Type:
English Abstract; Journal Article- Language:
German - Source:
- Additional Information
- Transliterated Title: Prognostische Faktoren bei einem schrittweisen Ansatz zur nicht-pharmakologischen Therapie von Sauerstoff und mechanischer Beatmung bis hin zur extrakorporalen Membranoxygenierung bei COVID-19.
- Source: Publisher: Thieme Country of Publication: Germany NLM ID: 8906641 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1438-8790 (Electronic) Linking ISSN: 09348387 NLM ISO Abbreviation: Pneumologie Subsets: MEDLINE
- Publication Information: Original Publication: Stuttgart ; New York : Thieme, [c1989-
- Subject Terms: Extracorporeal Membrane Oxygenation* ; COVID-19*/mortality ; COVID-19*/therapy ; Respiration, Artificial*; Humans ; Male ; Middle Aged ; Female ; Retrospective Studies ; Prognosis ; Germany/epidemiology ; Aged ; Oxygen Inhalation Therapy ; Respiratory Insufficiency/therapy ; Respiratory Insufficiency/mortality ; Precision Medicine ; Adult ; Noninvasive Ventilation
- Abstract: Background: Our centre followed a stepwise approach in the nonpharmacological treatment of respiratory failure in COVID-19 in accordance with German national guidelines, escalating non-invasive measures before invasive mechanical ventilation (IMV) or extracorporeal membrane oxygenation (ECMO). The aim of this study was to analyse this individualized approach to non-pharmacologic therapy in terms of patient characteristics and clinical features that may help predict more severe disease, particularly the need for intensive care.
Method: This retrospective single-centre study of COVID-19 inpatients between March 2020 and December 2021 analysed anthropometric data, non-pharmacological maximum therapy and survival status via a manual medical file review.
Results: Of 1052 COVID-19-related admissions, 835 patients were included in the analysis cohort (54% male, median 58 years); 34% (n=284) received no therapy, 40% (n=337) conventional oxygen therapy (COT), 3% (n=22) high flow nasal cannula (NHFC), 9% (n=73) continuous positive airway pressure (CPAP), 7% (n=56) non-invasive ventilation (NIV), 4% (n=34) intermittent mandatory ventilation (IMV), and 3% (n=29) extracorporeal membrane oxygenation (ECMO). Of 551 patients treated with at least COT, 12.3% required intubation. A total of 183 patients required ICU treatment, and 106 (13%) died. 25 (74%) IMV patients and 23 (79%) ECMO patients died. Arterial hypertension, diabetes and dyslipidemia was more prevalent in non-survivors. Binary logistic analysis revealed the following risk factors for increased mortality: an oxygen supplementation of ≥2 L/min at baseline (OR 6.96 [4.01-12.08]), age (OR 1.09 [1.05-1.14]), and male sex (OR 2.23 [0.79-6.31]).
Conclusion: The physician's immediate clinical decision to provide oxygen therapy, along with other recognized risk factors, plays an important role in predicting the severity of the disease course and thus aiding in the management of COVID-19.
Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.
(Thieme. All rights reserved.) - Contributed Indexing: Local Abstract: [Publisher, German] Unser Zentrum verfolgte bei der nicht-pharmakologischen Behandlung des Atemversagens bei COVID-19 in Übereinstimmung mit den deutschen nationalen Leitlinien einen schrittweisen Ansatz, bei dem die nicht-invasiven Maßnahmen vor der invasiven mechanischen Beatmung (IMV) oder der extrakorporalen Membranoxygenierung (ECMO) eskaliert wurden. Das Ziel dieser Studie war, diesen individualisierten Ansatz der nicht-pharmakologischen Therapie im Hinblick auf die Patientencharakteristika und klinische Merkmale zu analysieren, die bei der Vorhersage einer schwereren Erkrankung – insbesondere einer erforderlichen intensivmedizinischen Behandlung – helfen können. [Publisher, German] Diese retrospektive, monozentrische Studie an stationären COVID-19-Patienten zwischen März 2020 und Dezember 2021 analysierte anthropometrische Daten, nicht-pharmakologische Maximaltherapie und Überlebensstatus auf Basis der in den Patientenakten dokumentierten Daten. [Publisher, German] Von 1052 COVID-19-bedingten Einweisungen wurden 835 Patienten in die Analysekohorte aufgenommen (54% männlich, Median 58 Jahre). 34% (n=284) erhielten keine Therapie, 40% (n=337) konventionelle Sauerstofftherapie (COT), 3% (n=22) High-Flow-Nasenkanüle (HFNC), 9% (n=73) kontinuierlichen Atemwegspositivdruck (CPAP), 7% (n=56) nicht-invasive Beatmung (NIV), 4% (n=34) invasive mechanische Ventilation (IMV) und 3% (n=29) extrakorporale Membranoxygenierung (ECMO) als maximale Therapie. Von 551 Patienten, die mindestens mit COT behandelt wurden, mussten 12,3% intubiert werden. Insgesamt mussten 183 Patienten auf der Intensivstation behandelt werden und 106 (13%) starben. 25 (74%) IMV-Patienten und 23 (79%) ECMO-Patienten verstarben. Verstorbene litten häufiger an arterieller Hypertonie, Demenz, Diabetes und Dyslipidämie. Die logistische Regression zeigte folgende Risikofaktoren für die Sterblichkeit: eine Sauerstoffbedarf von ≥2 L/min bei Studienbeginn (OR 6,96 [4,01–12,08]), Alter (OR 1,09 [1,05–1,14]) und männliches Geschlecht (OR 2,23 [0,79–6,31]). [Publisher, German] Die unmittelbare klinische Entscheidung des Arztes für eine Sauerstofftherapie spielt neben anderen anerkannten Risikofaktoren eine wichtige Rolle bei der Vorhersage des Schweregrads des Krankheitsverlaufs und damit bei der Behandlung von COVID-19.
- Publication Date: Date Created: 20240129 Date Completed: 20240719 Latest Revision: 20240719
- Publication Date: 20240720
- Accession Number: 10.1055/a-2235-6357
- Accession Number: 38286417
- Transliterated Title:
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