INTRODUCTION: COVID-19-associated lung injury distinguishes from classic ARDS in its pathophysiological mechanisms Lower threshold of P/F ratio as an indication for invasive ventilation can probably improve overall survival by decreasing the amount of intubations and associated complications METHODS: Two comparable ICUs of the hospital were divided on the basis of the respiratory management approaches For the intubation conservative approach P/F ratio were assumed &lt;150 mmHg and liberal approach were assumed &lt;110 mmHg Other treatment protocols, including other indications for invasive mechanical ventilation, were identical The primary endpoints were in-hospital mortality, duration of hospital stay, duration of ICU stay;secondary endpoints were the frequency of major bleeding, thrombotic complications, acute kidney injury, vasopressors use, bacterial co-infection RESULTS: There were 34 patients in the conservative group and 27 patients in the liberal group The groups were comparable in age, sex, comorbidities, drug therapy on admission, CRP and IL-6 levels, severity of lung injury The MV was used in 91 2% and NIV in 29 4% (76 9% was switched to MV) in the conservative group In the liberal group, MV was used in 48 1% of patients and NIV in 74 1% of patients (30 0% was switched to MV) We observed the significant reduction of the in-hospital mortality in the liberal group in comparison with the conservative group (51 9% vs 76 5%, p = 0 044) There was no significant difference in the other primary endpoints between two groups For secondary endpoints, statistically significant differences were obtained in the incidence of bacterial co-infection (61 8% versus 30 8%, p = 0 017);and venous thrombosis (14 7% versus 0%, p = 0 041) There were no significant difference in the other secondary endpoints CONCLUSIONS: In patients with severe COVID-19- associated lung injury, following the classical protocol for determining indications for invasive MV leads to a significant increase in the incidence of venous thrombosis, bacterial co-infection, and mortality in comparison with the liberal approach, which turned out to be valid and demonstrated an advantage in such patients
Conservative and liberal approaches in determining indications for invasive ventilation in COVID-19