Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort.

Wendel Garcia, Pedro D; Aguirre-Bermeo, Hernán; Buehler, Philipp K; Alfaro-Farias, Mario; Yuen, Bernd; David, Sascha; Tschoellitsch, Thomas; Wengenmayer, Tobias; Korsos, Anita; Fogagnolo, Alberto; Kleger, Gian-Reto; Wu, Maddalena A; Colombo, Riccardo; Turrini, Fabrizio; Potalivo, Antonella; Rezoagli, Emanuele; Rodríguez-García, Raquel; Castro, Pedro; Lander-Azcona, Arantxa; Martín-Delgado, Maria C; ... (2021). Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort. Critical care, 25(1), p. 175. BioMed Central 10.1186/s13054-021-03580-y

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Uncertainty about the optimal respiratory support strategies in critically ill COVID-19 patients is widespread. While the risks and benefits of noninvasive techniques versus early invasive mechanical ventilation (IMV) are intensely debated, actual evidence is lacking. We sought to assess the risks and benefits of different respiratory support strategies, employed in intensive care units during the first months of the COVID-19 pandemic on intubation and intensive care unit (ICU) mortality rates.


Subanalysis of a prospective, multinational registry of critically ill COVID-19 patients. Patients were subclassified into standard oxygen therapy ≥10 L/min (SOT), high-flow oxygen therapy (HFNC), noninvasive positive-pressure ventilation (NIV), and early IMV, according to the respiratory support strategy employed at the day of admission to ICU. Propensity score matching was performed to ensure comparability between groups.


Initially, 1421 patients were assessed for possible study inclusion. Of these, 351 patients (85 SOT, 87 HFNC, 87 NIV, and 92 IMV) remained eligible for full analysis after propensity score matching. 55% of patients initially receiving noninvasive respiratory support required IMV. The intubation rate was lower in patients initially ventilated with HFNC and NIV compared to those who received SOT (SOT: 64%, HFNC: 52%, NIV: 49%, p = 0.025). Compared to the other respiratory support strategies, NIV was associated with a higher overall ICU mortality (SOT: 18%, HFNC: 20%, NIV: 37%, IMV: 25%, p = 0.016).


In this cohort of critically ill patients with COVID-19, a trial of HFNC appeared to be the most balanced initial respiratory support strategy, given the reduced intubation rate and comparable ICU mortality rate. Nonetheless, considering the uncertainty and stress associated with the COVID-19 pandemic, SOT and early IMV represented safe initial respiratory support strategies. The presented findings, in agreement with classic ARDS literature, suggest that NIV should be avoided whenever possible due to the elevated ICU mortality risk.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Jeitziner, Marie-Madlen


600 Technology > 610 Medicine & health




BioMed Central




Jsabelle Arni

Date Deposited:

22 Jun 2021 17:20

Last Modified:

27 Jun 2021 03:07

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

ARDS COVID-19 High flow oxygen therapy Invasive mechanical ventilation Noninvasive mechanical ventilation Patient self-inflicted lung injury Respiratory support Standard oxygen therapy




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