Sixty-day mortality among 520 Italian hospitalized COVID-19 patients according to the adopted ventilatory strategy in the context of an integrated multidisciplinary clinical organization: a population-based cohort study

  1. Antonella Potalivo
  2. Jonathan Montomoli
  3. Francesca Facondini
  4. Gianfranco Sanson
  5. Luigi Arcangelo Lazzari Agli
  6. Tiziana Perin
  7. Francesco Cristini
  8. Enrico Cavagna
  9. Raffaella De Giovanni
  10. Carlo Biagetti
  11. Ilaria Panzini
  12. Cinzia Ravaioli
  13. Maddalena Bitondo
  14. Daniela Guerra
  15. Giovanni Giuliani
  16. Elena Mosconi
  17. Sonia Guarino
  18. Elisa Marchionni
  19. Gianfilippo Gangitano
  20. Ilaria Valentini
  21. Luca Giampaolo
  22. Francesco Muratore
  23. Giuseppe Nardi
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Abstract

Background

Among COVID-19 patients, the decision of which ventilation strategy to adopt is crucial and not guided by existing outcome evidence. We described the clinical characteristics and outcomes of hospitalized COVID-19 patients according to the adopted respiratory strategy.

Methods

Population-based cohort study including all COVID-19 patients (26/02/2020-18/04/2020) within Rimini Italian province. Hospitalized patients were classified according to the maximum level of respiratory support: oxygen supplementation (group Oxygen), NIV (group NIV-only), IMV (group IMV-only), and IMV after a NIV trial (group IMV-after-NIV). Sixty-day mortality risk was estimated with a Cox proportional hazard analysis adjusted by age, sex, and administration of steroids, canakinumab, and tocilizumab.

Findings

We identified 1,424 symptomatic patients: 520 (36.5%) were hospitalized, the remaining 904 (63.5%) were treated at home with no 60-days death. According to the respiratory support, 408 (78.5%) were assigned to Oxygen, 46 (8.8%) to NIV-only, 25 (4.8%) to IMV-after-NIV, and 41 (7.9%) to IMV-only groups. There was no significant difference in the P/F at IMV inception among IMV-after-NIV and IMV-only groups (p=0.9). Overall 60-day mortality was 24.2% (Oxygen: 23.0%; NIV-only: 19.6%; IMV-after-NIV: 32.0%; IMV-only: 36.6%; p = 0.165). Compared with Oxygen group, the 60-day mortality risk significantly increased for IMV-after-NIV (HR 2.776; p=0.024) and IMV-only group (HR 2.966; p=0.001).

Conclusions

This study provides a population-based figure of the impact of the COVID-19 epidemic. A similar 60-days mortality risk was found for patients undergoing immediate IMV and those intubated after a NIV trial. Many patients had a favorable outcome after prolonged IMV.

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