Abstract
Introduction: We analyzed the association of age with ventilation practice and outcomes in critically ill COVID–19 patients requiring invasive ventilation.Methods: Posthoc analysis of the PRoVENT–COVID study, an observational study performed in 22 ICUs in the first 3 months of the national outbreak in the Netherlands. The coprimary endpoint was a set of ventilator parameters, including tidal volume normalized for predicted bodyweight, positive end–expiratory pressure, driving pressure, and respiratory system compliance in the first 4 days of invasive ventilation. Secondary endpoints were other ventilation parameters, the use of rescue therapies, pulmonary and extrapulmonary complications in the first 28 days in the ICU, hospital– and ICU stay, and mortality.Results: 1122 patients were divided into four groups based on age quartiles. No meaningful differences were found in ventilation parameters and in the use of rescue therapies for refractory hypoxemia in the first 4 days of invasive ventilation. Older patients received more often a tracheostomy, developed more frequently acute kidney injury and myocardial infarction, stayed longer in hospital and ICU, and had a higher mortality.Conclusions: In this cohort of invasively ventilated critically ill COVID–19 patients, age had no effect on ventilator management. Higher age was associated with more complications, longer length of stay in ICU and hospital and a higher mortality.
Highlights
We analyzed the association of age with ventilation practice and outcomes in critically ill COVID– 19 patients requiring invasive ventilation
The coronavirus disease 2019 (COVID–19) pandemic has resulted in worldwide recurrent surges of patients in need for urgent and intense medical care [1], and as of early–November 2021 5 million patients have died from this new disease [2]
This study included more than 40% of all critically ill COVID–19 patients admitted to a Dutch intensive care unit (ICU) in the first 3 months of the national outbreak
Summary
We analyzed the association of age with ventilation practice and outcomes in critically ill COVID– 19 patients requiring invasive ventilation. Many hospitalized COVID–19 patients need admission to an intensive care unit (ICU), most often for escalation of respiratory support that includes invasive ventilation [3]. One small prospective cohort study showed that elderly patients with acute respiratory failure received ventilation with lower pressures compared to younger patients [6]. This was not confirmed by a more recently published study, showing no age dependent variations in ventilator settings in such patients [7]
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