Associated factors with patients'outcome after ICU. Role of the frailty score

La vision de la mission de soins intensifs est progressivement en train de se modifier. Essentiellement axée sur la survie de patients gravement atteints dans leur santé, la médecine intensive s'est développée durant les premières décennies ayant comme seul indicateur leur survie. Une évolution exponentielle des moyens tant sur le point technologique que le savoir-faire des soignants médico-infirmier a permis d'assurer un nombre toujours plus important de survie. Toutefois, l'acquisition des connaissances de ces 20 dernières années démontrent que les patients survivent parfois dans des conditions de santé psychiques et somatiques qu'ils n'auraient peut-être pas souhaitées. Les objectifs de la médecine intensive doit aujourd'hui aller plus loin que la survie, mais viser une survie de qualité. Le présent travail décrit les facteurs associés au devenir à court et long-terme de patients avec un accent particulier sur le score de frailty, un facteur d'intérêt potentiel pour les intensivistes de demain

Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort.

BACKGROUND Uncertainty about the optimal respiratory support strategies in critically ill COVID-19 patients is widespread. While the risks and benefits of noninvasive techniques versus early invasive mechanical ventilation (IMV) are intensely debated, actual evidence is lacking. We sought to assess the risks and benefits of different respiratory support strategies, employed in intensive care units during the first months of the COVID-19 pandemic on intubation and intensive care unit (ICU) mortality rates. METHODS Subanalysis of a prospective, multinational registry of critically ill COVID-19 patients. Patients were subclassified into standard oxygen therapy ≥10 L/min (SOT), high-flow oxygen therapy (HFNC), noninvasive positive-pressure ventilation (NIV), and early IMV, according to the respiratory support strategy employed at the day of admission to ICU. Propensity score matching was performed to ensure comparability between groups. RESULTS Initially, 1421 patients were assessed for possible study inclusion. Of these, 351 patients (85 SOT, 87 HFNC, 87 NIV, and 92 IMV) remained eligible for full analysis after propensity score matching. 55% of patients initially receiving noninvasive respiratory support required IMV. The intubation rate was lower in patients initially ventilated with HFNC and NIV compared to those who received SOT (SOT: 64%, HFNC: 52%, NIV: 49%, p = 0.025). Compared to the other respiratory support strategies, NIV was associated with a higher overall ICU mortality (SOT: 18%, HFNC: 20%, NIV: 37%, IMV: 25%, p = 0.016). CONCLUSION In this cohort of critically ill patients with COVID-19, a trial of HFNC appeared to be the most balanced initial respiratory support strategy, given the reduced intubation rate and comparable ICU mortality rate. Nonetheless, considering the uncertainty and stress associated with the COVID-19 pandemic, SOT and early IMV represented safe initial respiratory support strategies. The presented findings, in agreement with classic ARDS literature, suggest that NIV should be avoided whenever possible due to the elevated ICU mortality risk