Association of ventilator type with hospital mortality in critically ill patients with SARS-CoV2 infection: a prospective study
Authors: Ferré Alexis , Marquion Fabien , Delord Marc , Gros Antoine , Lacave Guillaume , Laurent Virginie , Merceron Sybille , Paul Marine , Simon Christelle , Troché Gilles , Charbonnel Clément , Marque-Juillet Stéphanie , Bruneel Fabrice , Legriel Stéphane ,   the RESPI-COVID19 Study Group, Abbad Sofia , Abi Abdallah Georges , Ahmed Passem , Amara Marlène , Arrayago Marine , Aubry Alix , Bargain Pauline , Bédos Jean-Pierre , Bellut Hugo , Benayoun Michael , Benhamida Hotman , Benchetrit Laura , Benhard Johan , Boglietto Emilie , Bordier Raphaelle , Brizard Antoine , Cambriel Amélie , Causeret Steven , Convers-Domart Raphaële , Chinardet Paul , Codorniu Anaïs , Coeffic Adrien , de Carrere Wandrille , Dekeyser Cyril , Delaroche Alix , Descamps Chloé , Didier Juliette , Dorges Pascaline , Fanet Lucie , Fauquenot Camille , Flaujac Claire , Gouzien Laura , Grandière Louis , Henao-Brasseur Juliana , Heymann Jean-Didier , Hickel Charles , Jullien Philippe , Lamamri Myriam , Le Clec’h Bénédicte , Lessert Marc , Le Tulzo Yves , Livarek Bernard , Maurizot Aurélien , Metzger Céline , Michon Hervé , Minin Marie-Sophie , Nid-Bella Ghislane , Offredo Marianne , Ouassou Amael , Paktoris Hanna , Perier François , Picq Olivia , Poirier Hélène , Raphalen Jean-Herlé , Roche Anne , Roujansky Ariane , Quenesson Thomas , Rouaux Jil , Sabau Lucie , Saleten Marie , Salvetti Marie , Sarfati Florence , Squara Pierre , Teissedre Celia , Terris Manon , Stephan François , Tamion Fabienne , Vax Jean-François , Veber Benoît , Vernet Cécile , Wormser Alexandre 
Published: February 2022

Abstract
Background
To evaluate the association between ventilator type and hospital mortality in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (SARS-CoV2 infection), a single-center prospective observational study in France.

Results
We prospectively included consecutive adults admitted to the intensive care unit (ICU) of a university-affiliated tertiary hospital for ARDS related to proven COVID-19, between March 2020 and July 2021. All patients were intubated. We compared two patient groups defined by whether an ICU ventilator or a less sophisticated ventilator such as a sophisticated turbine-based transport ventilator was used. Kaplan–Meier survival curves were plotted. Cox multivariate regression was performed to identify associations between patient characteristics and hospital mortality. We included 189 patients (140 [74.1%] men) with a median age of 65 years [IQR, 55–73], of whom 61 (32.3%) died before hospital discharge. By multivariate analysis, factors associated with in-hospital mortality were age ≥ 70 years (HR, 2.11; 95% CI, 1.24–3.59; P = 0.006), immunodeficiency (HR, 2.43; 95% CI, 1.16–5.09; P = 0.02) and serum creatinine ≥ 100 µmol/L (HR, 3.01; 95% CI, 1.77–5.10; P < 0.001) but not ventilator type. As compared to conventional ICU (equipped with ICU and anesthesiology ventilators), management in transient ICU (equipped with non-ICU turbine-based ventilators) was associated neither with a longer duration of invasive mechanical ventilation (18 [IQR, 11–32] vs. 21 [13–37] days, respectively; P = 0.39) nor with a longer ICU stay (24 [IQR, 14–40] vs. 27 [15–44] days, respectively; P = 0.44).

Conclusions
In ventilated patients with ARDS due to COVID-19, management in transient ICU equipped with non-ICU sophisticated turbine-based ventilators was not associated with worse outcomes compared to standard ICU, equipped with ICU ventilators. Although our study design is not powered to demonstrate any difference in outcome, our results after adjustment do not suggest any signal of harm when using these transport type ventilators as an alternative to ICU ventilators during COVID-19 surge.