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Publication Details

Title :

Noninvasive ventilation in critically ill patients with the Middle East respiratory syndrome

Journal:

Influenza Other Respir Viruses

Impact Factor:

3.094

Authors:

Alraddadi BM1,2, Qushmaq I1, Al-Hameed FM3, Mandourah Y4, Almekhlafi GA4, Jose J5, Al-Omari A6, Kharaba A7, Almotairi A8, Al Khatib K9, Shalhoub S10,11, Abdulmomen A12, Mady A13,14, Solaiman O15, Al-Aithan AM16, Al-Raddadi R17, Ragab A18, Balkhy HH19, Al Harthy A14, Sadat M20, Tlayjeh H20, Merson L21, Hayden FG22, Fowler RA23, Arabi YM20; Saudi Critical Care Trials Group.

Affiliations:

1 Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.

2 Department of Medicine, University of Jeddah, Jeddah, Saudi Arabia.

3 Department of Intensive Care, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia.

4 Prince Sultan Military Medical City, Military Medical Services, Ministry of Defense, Riyadh, Saudi Arabia.

5 Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

6 Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.

7 Department of Critical Care, Ohoud Hospitals, King Fahad Hospital, Al-Madinah Al-Monawarah, Saudi Arabia.

8 Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia.

9 Intensive Care Department, Al-Noor Specialist Hospital, Makkah, Saudi Arabia.

10 Department of Medicine, Division of Infectious Diseases, University of Western Ontario, London, Canada.

11 Department of Medicine, Division of Infectious Diseases, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.

12 King Saud University, Riyadh, Saudi Arabia.

13 Department of Anesthesiology, Intensive Care, Tanta University Hospitals, Tanta, Egypt.

14 Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia.

15 King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

16 Intensive Care Department, King Abdulaziz Hospital, Al Ahsa, Saudi Arabia.

17 Department of Family and Community Medicine, King Abdulaziz University Hospital, Ministry of Health, Jeddah, Saudi Arabia.

18 Intensive Care Department, King Fahd Hospital, Jeddah, Saudi Arabia.

19 Infection Prevention and Control Department, King Abdullah International Medical Research Center, College of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

20 Intensive Care Department, King Abdullah International Medical Research Center, College of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

21 Infectious Diseases Data Observatory, Churchill Hospital, Oxford University, International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), Headington, UK.

22 Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), Charlottesville, Virginia.

23 Department of Critical Care Medicine and Department of Medicine, Sunnybrook Hospital, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada

Year of Publication:

2019

DOI:

10.1111/irv.12635

Abstract:

BACKGROUND:
Noninvasive ventilation (NIV) has been used in patients with the Middle East respiratory syndrome (MERS) with acute hypoxemic respiratory failure, but the effectiveness of this approach has not been studied.

METHODS:
Patients with MERS from 14 Saudi Arabian centers were included in this analysis. Patients who were initially managed with NIV were compared to patients who were managed only with invasive mechanical ventilation (invasive MV).

RESULTS:
Of 302 MERS critically ill patients, NIV was used initially in 105 (35%) patients, whereas 197 (65%) patients were only managed with invasive MV. Patients who were managed with NIV initially had lower baseline SOFA score and less extensive infiltrates on chest radiograph compared with patients managed with invasive MV. The vast majority (92.4%) of patients who were managed initially with NIV required intubation and invasive mechanical ventilation, and were more likely to require inhaled nitric oxide compared to those who were managed initially with invasive MV. ICU and hospital length of stay were similar between NIV patients and invasive MV patients. The use of NIV was not independently associated with 90-day mortality (propensity score-adjusted odds ratio 0.61, 95% CI [0.23, 1.60] P = 0.27).

CONCLUSIONS:
In patients with MERS and acute hypoxemic respiratory failure, NIV failure was very high. The use of NIV was not associated with improved outcomes.