Low tidal volume ventilation is associated with mortality in COVID-19 patients—Insights from the PRoVENT-COVID study
Issued Date
2022-08-01
Resource Type
ISSN
08839441
eISSN
15578615
Scopus ID
2-s2.0-85129643591
Pubmed ID
35490503
Journal Title
Journal of Critical Care
Volume
70
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Critical Care Vol.70 (2022)
Suggested Citation
Nijbroek S.G.L.H., Hol L., Ivanov D., Schultz M.J., Paulus F., Neto A.S. Low tidal volume ventilation is associated with mortality in COVID-19 patients—Insights from the PRoVENT-COVID study. Journal of Critical Care Vol.70 (2022). doi:10.1016/j.jcrc.2022.154047 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85690
Title
Low tidal volume ventilation is associated with mortality in COVID-19 patients—Insights from the PRoVENT-COVID study
Other Contributor(s)
Abstract
Purpose: Low tidal volume ventilation (LTVV) is associated with mortality in patients with acute respiratory distress syndrome. We investigated the association of LTVV with mortality in COVID-19 patients. Methods: Secondary analysis of a national observational study in COVID-19 patients in the first wave of the pandemic. We compared COVID-19 patients that received LTVV, defined as controlled ventilation with a median tidal volume ≤ 6 mL/kg predicted body weight over the first 4 calendar days of ventilation, with patients that did not receive LTVV. The primary endpoint was 28-day mortality. In addition, we identified factors associated with use of LTVV. Results: Of 903 patients, 294 (32.5%) received LTVV. Disease severity scores and ARDS classification was not different between the two patient groups. The primary endpoint, 28-day mortality, was met in 68 out of 294 patients (23.1%) that received LTVV versus in 193 out of 609 patients (31.7%) that did not receive LTVV (P < 0.001). LTVV was independently associated with 28-day mortality (HR, 0.68 (0.45 to 0.95); P = 0.025). Age, height, the initial tidal volume and continuous muscle paralysis was independently associated with use of LTVV. Conclusions: In this cohort of invasively ventilated COVID-19 patients, approximately a third of patients received LTVV. Use of LTVV was independently associated with reduced 28-day mortality. The initial tidal volume and continuous muscle paralysis were potentially modifiable factors associated with use of LTVV. These findings are important as they could help clinicians to recognize patients who are at risk of not receiving LTVV.