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.

Students' knowledge of symptoms and risk factors of potential life-threatening medical conditions.

AIM: In order to assess medical students' knowledge of Basic Life Support (BLS) principles, we defined a minimal knowledge (MK) of three life-threatening medical conditions that should be universally known: cardiac arrest, heart attack and stroke, and compared the results with those of laypersons. METHODS: Before participating in a BLS course, 406 medical students and 101 laypersons completed an MK questionnaire. Additional data were collected on participants' gender, age, education, medical education, personal experience with the condition and successful completion of a BLS course. RESULTS: The mean proportion of correct answers was 48.1% for medical students and 34.3% for laypersons (P <0.001). No participant achieved a MK level of 100%. Multivariable analysis showed that medical background +14.8% MK (P <0.001), successful completion of a BLS course +4.4% MK (P = 0.004), and personal experience of the condition +3.2% MK (P = 0.013) significantly enhanced the MK percentage. Interaction analysis suggested that there were no exponential effects of higher education and medical background, or medical background and a completed BLS course. CONCLUSION: Among medical students and laypersons there is a significant lack of knowledge regarding the typical signs and risk factors associated with serious medical conditions. Within the current study, participants with direct experience of these conditions exhibited marginally improved knowledge compared to others, indicating a wide gap in the general public's knowledge. There is an urgent need to establish learning objectives in order to encourage students to complete BLS courses during their education.