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.

Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0355501 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1530-0293 (Electronic) Linking ISSN: 00903493 NLM ISO Abbreviation: Crit Care Med Subsets: MEDLINE

Publication: Philadelphia, PA : Lippincott Williams & Wilkins
Original Publication: New York, Kolen.

COVID-19*/therapy ; COVID-19*/mortality ; Hospital Mortality* ; Respiratory Distress Syndrome*/therapy ; Respiratory Distress Syndrome*/mortality ; Ventilators, Mechanical*/supply & distribution ; Ventilators, Mechanical*/statistics & numerical data; Humans ; Male ; Female ; Retrospective Studies ; Middle Aged ; Aged ; New York/epidemiology ; Respiration, Artificial/statistics & numerical data

Objectives: 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.
Competing Interests: Dr. Rolston’s institution received funding from Flosonics and Calcimedica. Dr. Cohen received funding from Phillips. Dr. Becker’s institution received funding from Phillips, Nihon Kohden, ZOLL Medical Corp, the National Institutes of Health, and United Therapeutics. Dr. Jafari’s institution received funding from Theravance Biopharma and the Zoll Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest.
(Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

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Date Created: 20240402 Date Completed: 20240613 Latest Revision: 20240910

20240911

10.1097/CCM.0000000000006252

38563609