Background: The coronavirus disease 2019 (COVID-19) pandemic is rapidly expanding across the world, with more than 100,000 new cases each day as of end-June 2020. Healthcare workers are struggling to provide the best care for COVID-19 patients. Approaches for invasive ventilation vary widely between and within countries and new insights are acquired rapidly. We aim to investigate invasive ventilation practices and outcome in COVID-19 patients in the Netherlands.Methods: PRoVENT-COVID ('study of PRactice of VENTilation in COVID-19') is an investigator-initiated national, multicenter observational study to be undertaken in intensive care units (ICUs) in The Netherlands. Consecutive COVID-19 patients aged 18 years or older, who are receiving invasive ventilation in the participating ICUs, are to be enrolled during a 10-week period, with a daily follow-up of 7 days. The primary outcome is ventilatory management (including tidal volume expressed as mL/kg predicted body weight and positive end-expiratory pressure expressed as cmH2O) during the first 3 days of ventilation. Secondary outcomes include other ventilatory variables, use of rescue therapies for refractory hypoxemia such as prone positioning and extracorporeal membrane oxygenation, use of sedatives, vasopressors and inotropes; daily cumulative fluid balances; acute kidney injury; ventilator-free days and alive at day 28 (VFD-28), duration of ICU and hospital stay, and ICU, hospital and 90-day mortality.Discussion: PRoVENT-COVID will be the largest observational study to date, with high density ventilatory data and major outcomes. There is urgent need for a better understanding of ventilation practices, and the effects of ventilator settings on outcomes in COVID-19 patients. The results of PRoVENT-COVID will be rapidly disseminated through electronic presentations, such as webinars and electronic conferences, and publications in international peer-reviewed journals. Access to source data will be made available through local, regional and national anonymized datasets on request, and after agreement of the PRoVENT-COVID steering committee.Trial Registration: PRoVENT-COVID is registered at clinicaltrials.gov (identifier NCT04346342).
BACKGROUND The mechanical power of ventilation (MP) has an association with outcome in invasively ventilated patients with the acute respiratory distress syndrome (ARDS). Whether a similar association exists in invasively ventilated patients without ARDS is less certain.OBJECTIVE To investigate the association of mechanical power with mortality in ICU patients without ARDS.DESIGN This was an individual patient data analysis that uses the data of three multicentre randomised trials.SETTING This study was performed in academic and nonacademic ICUs in the Netherlands.PATIENTS One thousand nine hundred and sixty-two invasively ventilated patients without ARDS were included in this analysis. The median [IQR] age was 67 [57 to 75] years, 706 (36%) were women.MAIN OUTCOME MEASURES The primary outcome was the all-cause mortality at day 28. Secondary outcomes were the all-cause mortality at day 90, and length of stay in ICU and hospital.RESULTS At day 28, 644 patients (33%) had died. Hazard ratios for mortality at day 28 were higher with an increasing MP, even when stratified for its individual components (driving pressure (P < 0.001), tidal volume (P < 0.001), respiratory rate (P < 0.001) and maximum airway pressure (P = 0.001). Similar associations of mechanical power (MP) were found with mortality at day 90, lengths of stay in ICU and hospital. Hazard ratios for mortality at day 28 were not significantly different if patients were stratified for MP, with increasing levels of each individual component.CONCLUSION In ICU patients receiving invasive ventilation for reasons other than ARDS, MP had an independent association with mortality. This finding suggests that MP holds an added predictive value over its individual components, making MP an attractive measure to monitor and possibly target in these patients.TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02159196, ClinicalTrials.gov Identifier: NCT02153294, ClinicalTrials.gov Identifier: NCT03167580.
The primary aims of this study were (1) to evaluate whole-body mechanical efficiency (ME) in a large group of chronic obstructive pulmonary disease (COPD) patients with a wide range of degrees of illness and (2) to examine how ME in COPD is related to absolute work rate and indices of disease severity during exercise testing. A total of 569 patients (301 male patients; GOLD stage I: 28, GOLD stage II: 166, GOLD stage III: 265, and GOLD stage IV: 110) with chronic obstructive pulmonary disease (COPD) were included in the data analysis. Individual maximal workload (watt), peak minute ventilation ((Equation is included in full-text article.)E, L/min body temperature and pressure, saturated), and peak oxygen uptake ((Equation is included in full-text article.)O2, mL/min standard temperature and pressure, dry) were determined from a maximal incremental cycle ergometer test. Ventilatory and metabolic response parameters were collected during a constant work rate test at 75% of the individual maximal workload. From the exercise responses of the constant work rate test, the gross ME was calculated. The mean whole-body gross ME was 11.0 ± 3.5% at 75% peak power. The ME declined significantly (P < .001) with increasing severity of the disease when measured at the same relative power. Log-transformed absolute work rate (r = .87, P < .001) was the strongest independent predictor of gross ME. Body mass was the single other variable that contributed significantly to the linear regression model. Gross ME in COPD was largely predicted by the absolute work rate (r = .87; P < .001) while indices of the severity of the disease did not predict ME in COPD.
