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- Title
The repurposed use of anesthesia machines to ventilate critically ill patients with coronavirus disease 2019 (COVID-19).
- Authors
Bottiroli, Maurizio; Calini, Angelo; Pinciroli, Riccardo; Mueller, Ariel; Siragusa, Antonio; Anelli, Carlo; Urman, Richard D.; Nozari, Ala; Berra, Lorenzo; Mondino, Michele; Fumagalli, Roberto
- Abstract
Background: The surge of critically ill patients due to the coronavirus disease-2019 (COVID-19) overwhelmed critical care capacity in areas of northern Italy. Anesthesia machines have been used as alternatives to traditional ICU mechanical ventilators. However, the outcomes for patients with COVID-19 respiratory failure cared for with Anesthesia Machines is currently unknow. We hypothesized that COVID-19 patients receiving care with Anesthesia Machines would have worse outcomes compared to standard practice. Methods: We designed a retrospective study of patients admitted with a confirmed COVID-19 diagnosis at a large tertiary urban hospital in northern Italy. Two care units were included: a 27-bed standard ICU and a 15-bed temporary unit emergently opened in an operating room setting. Intubated patients assigned to Anesthesia Machines (AM group) were compared to a control cohort treated with standard mechanical ventilators (ICU-VENT group). Outcomes were assessed at 60-day follow-up. A multivariable Cox regression analysis of risk factors between survivors and non-survivors was conducted to determine the adjusted risk of death for patients assigned to AM group. Results: Complete daily data from 89 mechanically ventilated patients consecutively admitted to the two units were analyzed. Seventeen patients were included in the AM group, whereas 72 were in the ICU-VENT group. Disease severity and intensity of treatment were comparable between the two groups. The 60-day mortality was significantly higher in the AM group compared to the ICU-vent group (12/17 vs. 27/72, 70.6% vs. 37.5%, respectively, p = 0.016). Allocation to AM group was associated with a significantly increased risk of death after adjusting for covariates (HR 4.05, 95% CI: 1.75–9.33, p = 0.001). Several incidents and complications were reported with Anesthesia Machine care, raising safety concerns. Conclusions: Our results support the hypothesis that care associated with the use of Anesthesia Machines is inadequate to provide long-term critical care to patients with COVID-19. Added safety risks must be considered if no other option is available to treat severely ill patients during the ongoing pandemic. Clinical trial number: Not applicable.
- Subjects
ITALY; ANESTHESIA equipment; INTENSIVE care units; EVALUATION of medical care; COVID-19; RESPIRATORY insufficiency; CONFIDENCE intervals; CRITICALLY ill; MULTIPLE regression analysis; MORTALITY; PATIENTS; TERTIARY care; ARTIFICIAL respiration; SEVERITY of illness index; DESCRIPTIVE statistics; METROPOLITAN areas
- Publication
BMC Anesthesiology, 2021, Vol 21, Issue 1, p1
- ISSN
1471-2253
- Publication type
Article
- DOI
10.1186/s12871-021-01376-9