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& Kress, J. P. Effect of noninvasive ventilation delivered helmet vs. face mask on the rate of endotracheal intubation in patients with acute respiratory distress syndrome: A randomized clinical trial. Nevertheless, we do not think it may have influenced our results, because analyses were adjusted for relevant treatments such as systemic corticosteroids40 and included the time period as a covariate. College Station, TX: StataCorp LLC. Patients were treated and monitored continuously in adapted respiratory wards, with improved monitoring and increased nurse-patient ratio (1:4 to 1:6 in wards, and from 1:2 to 1:4 in high-dependency units). In addition, 43% of our patients received tocilizumab and 28.2% where enrolled in a blinded clinical trial of investigational drugs targeting the inflammatory cascade. People who had severe illness with COVID-19 might experience organ damage affecting the heart, kidneys, skin and brain. 1), which was approved by the research ethics committee at each participating hospital (study coordinator centre, Hospital Vall d'Hebron, Barcelona; protocol No. Recommended approaches to minimize aerosol dispersion of SARS-CoV-2 during noninvasive ventilatory support can cause ventilator performance deterioration: A benchmark comparative study. Chest 158, 10461049 (2020). The dose and duration of steroids were based on the study by Villar J. et al, that showed an improvement in survival in patients with ARDS after using dexamethasone [33, 34]. Cite this article. This was an observational study conducted at a single health care system in a confined geographic area thus limiting the generalizability of our results. Amy Carr, Sergi Marti. 56, 1118 (2020). Until now, most of the ICU reports from United States have shown that severe COVID-19-associated ARDS (CARDS) is associated with prolonged MV and increased mortality [3]. The 90-days mortality rate will be the primary outcome, whereas IMV days, hospital/CU . Of the 156 patients with healthy kidneys, 32 (21%) died in the hospital, in contrast with 81 of 168 patients (48%) with newly developed kidney injury and 11 of 22 (50%) with CKD stage 1 through 4. Repeat tests were performed after an initial negative test by obtaining a lower respiratory sample if there was a high clinical pretest probability of COVID-19. Cinesi Gmez, C. et al. Among 429 admissions during the study period in this large observational study in Florida, 131 were admitted to the ICU (30.5%). Patients were characterized based on demographics, baseline comorbidities, severity of illness, medical management including experimental therapies, laboratory markers and ventilator parameters. This could be done by supporting breathing through supplying oxygen or ventilation, or by supporting patients if the . Nonlinear imputation of PaO2/FiO2 from SpO2/FiO2 among patients with acute respiratory distress syndrome. Cardiac arrest survival rates Email 12/22/2022-Handy. HFNC was not used during breaks in the NIV or CPAP groups due to the limited availability of devices in the first wave of the pandemics. All participating hospitals belong to the National Health System of Catalonia, Spain, and attend a population of around 4.3 million inhabitants. Google Scholar. The REDCap consortium: Building an international community of software platform partners. However, as more home devices were used in the CPAP group (81.6% vs. 38% in the NIV group; Table S3), and better outcomes were recorded in the CPAP-treated patients, our result do not support this concern. Coronavirus disease 2019 (COVID-19) has affected over 7 million of people around the world since December 2019 and in the United States has resulted so far in more than 100,000 deaths [1]. Lower positive end expiratory pressure (PEEP) averages were observed in survivors [9.2 cm H2O (7.710.4)] vs non-survivors [10 (9.112.9] p = 0.004]. Guidance for the Role and Use of Non-invasive Respiratory Support in Adult Patients with COVID-19 (Suspected or Confirmed). The data used in these figures are considered preliminary, and the results may change with subsequent releases. Continuous positive airway pressure in COVID-19 patients with moderate-to-severe respiratory failure. We aimed to compare the outcome of patients with COVID-19 pneumonia and hypoxemic respiratory failure treated with high-flow oxygen administered via nasal cannula (HFNC), continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV), initiated outside the intensive care unit (ICU) in 10 university hospitals in Catalonia, Spain. Our study supports several guidelines37,38 that favor HFNC and CPAP over NIV for the treatment of HARF in COVID-19 patients, but to our knowledge no previous data have been published in support of this recommendation. Interestingly, only 6.9% of our study population was referred for ECMO, however our ECMO mortality was much lower than previously reported in the literature (11% compared to 94%) [36, 37]. On average about 98.2% of known COVID-19 patients in the U.S. survive, but each individual's chance of dying from the virus will vary depending on their age, whether they have an underlying . Critical revision of the manuscript for important intellectual content: S.M., A.-E.C., J.S., M.L., M.B., P.C., J.M.-L., S.M., J.F., J.G.-A. KaplanMeier curves described the crude event-free rate in each NIRS group and were compared by means of the log-rank test. Am. In this multicentre, observational real-life study, we aimed to compare the effects of high-flow oxygen administered via nasal cannula, continuous positive airway pressure, and noninvasive ventilation, initiated outside the intensive care unit, in preventing death or endotracheal intubation at 28days in patients with COVID-19. Thus, we believe that our results may be useful for a great number of physicians treating COVID-19 patients around the world. Our study was carried out during the first wave of the pandemics when the healthcare system was overwhelmed and many patients were treated outside ICU facilities. Where once about 60% of such patients survived at least 90 days in spring 2020, by the end of the year it was just under half. 10 Since COVID-19 developments are rapidly . Brown, S. M. et al. Sign up for the Nature Briefing newsletter what matters in science, free to your inbox daily. Docherty, A. AHCFD is comprised of 9 hospitals with a total of 2885 beds servicing the 8 million residents of Orange County and surrounding regions. Prophylactic anticoagulation ranged from unfractionated heparin at 5000 units subcutaneously (SC) every eight hours or enoxaparin 0.5 mg/kg SC daily to full anticoagulation with either an unfractionated heparin infusion or enoxaparin 1 mg/kg SC twice daily. Patient characteristics and clinical outcomes were compared by survival status of COVID-19 positive patients. What is the survival rate for ECMO patients? Franco, C. et al. Among the patients with COVID-19 CAP, mortalities, mechanical ventilators, ICU admissions, ICU stay, and hospital costs . Care. Chronic Dis. Sonja Andersen, J. How Covid survival rates have improved . Also, of note, 37.4% of our study population received convalescent plasma, and larger studies are underway to understand its role in the treatment of severe COVID-19 [14, 32]. Thille, A. W. et al. Multivariable Cox proportional-hazards regression models were used to estimate the hazard ratios (HR) for patients treated with NIV and CPAP as compared to HFNC (the reference group), adjusting for age, sex, and variables found to be significantly different between treatments at baseline (hospital, date of admission and sleep apnea). Amay Parikh, Finally, additional unmeasured factors might have played a significant role in survival. Future research should seek to identify and predict factors associated with mortality in COVID-19 populations admitted to the ICU. Eduardo Oliveira, Leonard, S. et al. Respir. 50, 1602426 (2017). https://isaric.tghn.org. Ferreyro, B. et al. The APACHE IVB score-predicted hospital and ventilator mortality was 17% and 21% respectively for patients with a discharge disposition (Table 4). 57, 2002524 (2021). Patients were also enrolled in institutional review board (IRB) approved studies for convalescent plasma and other COVID-19 investigational treatments. Share this post. However, the inclusion of patients was consecutive and the collection of variables was really comprehensive. In case of doubt, the final decision was discussed by the ethical committee at each centre. 117,076 inpatient confirmed COVID-19 discharges. In addition to NIRS treatment, conscious pronation was performed in some patients. No differences were found when we performed within NIRS-group comparisons according to settings applied (Table S8). Chalmers, J. D. et al. Because the true number of infections is much larger than just the documented cases, the actual survival rate of all COVID-19 infections is even higher than 98.2%. 10 COVID-19 patients may experience change in or loss of taste or smell. First, the observational design could have resulted in residual confounding by selection bias. 55, 2000632 (2020). This study has some limitations. Statistical significance was set at P<0.05. To minimize the importance of vaccination, an Instagram post claimed that the COVID-19 survival rate is over 99% for most age groups, while the COVID-19 vaccine's effectiveness was 94%. An increasing number of U.S. covid-19 patients are surviving after they are placed on mechanical ventilators, a last-resort measure that was perceived as a signal of impending death during the terrifying early days of the pandemic. High-flow nasal cannula in critically III patients with severe COVID-19. As with all observational studies, it is difficult to ascertain causality with ICU therapies as opposed to an association that existed due to the patients clinical conditions. Respir. Among the 367 patients included in the study, 155 were treated with HFNC (42.2%), 133 with CPAP (36.2%), and 79 with NIV (21.5%). 2a). Care. Full anticoagulation was given to 48 (N = 131, 36.6%) of the patients and 77 (N = 131, 58.8%) received high dose corticosteroids (methylprednisolone 40mg every 8 hours for 7 days or dexamethasone 20 mg every day for 5 days followed by 10 mg every day for 5 days). Drafting of the manuscript: S.M., A.-E.C. We followed ARDS network low PEEP, high FiO2 table in the majority of our cases [16]. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Excluding those patients who remained hospitalized (N = 11 [8.4% of 131] at the end of study period, adjusted hospital mortality of ICU patients was 21.6%. Natasha Baloch, Association of noninvasive oxygenation strategies with all-cause mortality in adults with acute hypoxemic respiratory failure: A systematic review and meta-analysis. However, the retrospective design of our study does not allow establishing a causative link between NIV and the worse clinical outcomes observed. There are several potential explanations for our study findings. Jason Price, R.N., Sanjay Pattani, M.D., Brett Spenst, M.B.A., Amanda Tarkowski, M.D., Fahd Ali, M.D., Otsanya Ochogbu, PharmD., Bassel Raad, M.D., Mohammad Hmadeh, M.D., Mehul Patel, M.D. The authors wish to thank Barcelona Research Network (BRN) for their logistical and administrative support and to Rosa Llria for her assistance and technical help in the edition of the paper. Reports of ICU mortality due to COVID-19 around the world and in the Unites States, in particular, have ranged from 2062% [7]. Carteaux, G. et al. NIRS treatments were applied continuously for at least 48h while controlling oxygen delivery to obtain a target oxygen saturation measured by pulse oximetry (SpO2) of 9296%21. A multivariate logistic regression model identified renal replacement therapy as a significant predictor of mortality in this dataset (p = 0.006) (Table 5). From a total of 419 candidate patients, we excluded those with: (1) respiratory failure not related to COVID-19 (e.g., cardiogenic pulmonary edema as primary cause of respiratory failure); (2) rejection or early intolerance to any NIRS treatment; (3) pregnancy; (4) nosocomial infection; and (5) PaCO2 above 45mm Hg. This study was approved by the institutional review board of AHCFD, which waived the requirement for individual patient consent for participation. Article ICU outcomes in patients with COVID-19 and predicted mortality. Our study describes the clinical characteristics and outcomes of patients with severe COVID-19 admitted to ICU in the largest health care system in the state of Florida, United States. J. Transplant Institute, AdventHealth Orlando, Orlando, Florida, United States of America, Affiliation: J. Despite these limitations, our experience and results challenge previously reported high mortality rates. These data are complementary and still useful later on by including some patients usually excluded from randomized studies; patients with do-not-intubate orders are an example and, obviously, they represent a challenge for the physician responsible to decide the best therapeutic strategy. Use the Previous and Next buttons to navigate the slides or the slide controller buttons at the end to navigate through each slide. Neil Finkler During the initial . This risk would be avoided in CPAP and HFNC because they improve oxygenation without changing tidal volume32,33. Gregory Ruppel, MD., Christian Hernandez, M.D., Hany Farag, M.D., Daryl Tol, Steven Smith, M.D., Michael Cacciatore, M.D., Warren Wylie, Amber Modani, Samantha Au-Yeung, Jim Moffett. So far, observational COVID-19 studies have suggested that either HFNC, CPAP or NIV may improve oxygenation and reduce the need for intubation or the risk of death13,14,15,16,17,18, but the effects of different NIRS techniques have been compared in few studies16,19,20. This retrospective cohort study was conducted at AdventHealth Central Florida Division (AHCFD), the largest health system in central Florida. 2019. Corrections, Expressions of Concern, and Retractions. Surviving sepsis campaign: Guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19). Respir. Third, crossovers could have been responsible for differences observed between NIRS treatments but their proportion was small (12%) and our results did not change when these patients were excluded. This reduces the ability of the lungs to provide enough oxygen to vital organs. Most patients were supported with mechanical ventilation. The overall survival rate for ventilated patients was 79%, 65% for those receiving ECMO. Published reports from other centers following our data collection period have suggested decreasing mortality with time and experience [38]. COVID-19 patients appear to need larger doses of sedatives while on a ventilator, and they're often intubated for longer periods than is typical for other diseases that cause pneumonia. The main strength of this study is, in our opinion, its real-life design that allows obtaining the effectiveness of these techniques in the clinical setting. "If you force too much pressure in, you can cause damage to the lungs," he said. The third international consensus definitions for sepsis and septic shock (Sepsis-3). Vaccinated COVID patients fare better on mechanical ventilation, data show A new study in JAMA Network Open suggests vaccinated COVID-19 patients intubated for mechanical ventilation had a higher survival rate than unvaccinated or partially vaccinated patients. Noninvasive respiratory support treatments were applied as ceiling of treatment in 140 patients (38%) (Table 3). Martin Cearras, Facebook. Mechanical ventilation to minimize progression of lung injury in acute respiratory failure. Storre, J. H. et al. Inspired oxygen fraction achieved with a portable ventilator: Determinant factors. Investigational treatments of uncertain efficacy were utilized when supported by available evidence at the time (Table 3). Severe covid-19 pneumonia has posed critical challenges for the research and medical communities. Your gift today will help accelerate vaccine development, gene therapies and new treatments. The average survival-to-discharge rate for adults who suffer in-hospital arrest is 17% to 20%. In the context of the pandemic and outside the intensive care unit setting, noninvasive ventilation for the treatment of moderate to severe hypoxemic acute respiratory failure secondary to COVID-19 resulted in higher mortality or intubation rate at 28days than high-flow oxygen or CPAP. In this context, the utility of tracheostomy has been questioned in this group of ill patients. The median age of the patients admitted to the ICU was 61 years (IQR 49.571.5). Twitter. In other words, on average, 98.2% of known COVID-19 patients in the U.S. survive. ARDS causes severe lung inflammation and leads to fluids accumulating in the alveoli, which are tiny air sacs in the lungs that transfer oxygen to the blood and remove carbon dioxide. However, the RECOVERY-RS study may have been underpowered for the comparison of HFNC vs conventional oxygen therapy due to early study termination and the number of crossovers among groups (11.5% of HFNC and 23.6% of conventional oxygen treated patients). In contrast, a randomized study of 110 COVID-19 patients admitted to the ICU found no differences in the 28-day respiratory support-free days (primary outcome) or mortality between helmet NIV. The Washington Post cited the study, published in the Lancet, on Tuesday, saying that most elderly Covid-19 patients put on ventilators at two New York hospitals did not survive. Initial laboratory testing was defined as the first test results available, typically within 24 hours of admission. A multicentre, retrospective cohort study of COVID-19 patients followed from NIRS initiation up to 28days or death, whichever occurred first. 2 Clinical types included (1) mild cases in which the patient had mild clinical symptoms and no imaging findings of pneumonia; (2) common cases in which the patient had fever, respiratory symptoms, and imaging manifestations of . (2021) ICU outcomes and survival in patients with severe COVID-19 in the largest health care system in central Florida. 13 more], Technical Notes Data are not nationally representative. Noninvasive ventilation of patients with acute respiratory distress syndrome. Second, patient-ventilator asynchronies might have arisen in NIV-treated patients making more difficult their management outside the ICU setting and thereby explaining, at least partially, their worse outcomes. The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC). We considered the following criteria to admit patients to ICU: 1) Oxygen saturation (O2 sat) less than 93% on more than 6 liters oxygen (O2) via nasal cannula (NC) or PO2 < 65 mmHg with 6 liters or more O2, or respiratory rate (RR) more than 22 per minute on 6 liters O2, 2) PO2/FIO2 ratio less than 300, 3) any patient with positive PCR test for SARS-CoV-2 already on requiring MV or with previous criteria. Victor Herrera, Am. KEY Points. Patients not requiring ICU level care were admitted to a specially dedicated isolation unit at each AHCFD hospital. 44, 439445 (2020). The majority (87.2%) of deaths occurred within the first 14 days of admission, with a median time-to-death of nine (IQR: 8-12) days. AdventHealth Orlando Central Florida Division, Orlando, Florida, United States of America. The authors also showed it prevented mechanical ventilation in patients requiring oxygen supplementation with an NNT of 47 (ARR 2.1). As mentioned above, NIV might have better outcomes in a more controlled setting allowing an optimal critical care39. The survival rate of ventilated patients increased from 76% in the first outbreak to 84% in the fifth outbreak (p < 0.001). Grieco, D. L. et al. A selected number of patients received remdesivir as part of the expanded access or compassionate use programs, as well as through the Emergency Use Authorization (EUA) supply distributed by the Florida Department of Health. Median C-reactive protein on hospital admission was 115 mg/L (IQR 59.3186.3; upper limit of normal 5 mg/L), median Ferritin was 848 ng/ml (IQR 4411541); upper limit of normal 336 ng/ml), D-dimer was 1.4 ug/mL (IQR 0.83.2; upper limit of normal 0.8 ug/mL), and IL-6 level was 18 pg/mL (IQR 746.5; upper limit of normal 2 pg/mL). ICU management, interventions and length of stay (LOS) of patients with COVID-19. Aliberti, S. et al. Parallel to the start of NIRS, the ceiling of care was determined considering the patients wishes (or those of their representatives), underlying comorbidities, and frailty22. Tocilizumab was utilized in 56 (43.7%), and 37 (28.2%) were enrolled in blinded placebo-controlled studies aimed at the inflammatory cascade. 2b,c, Table 4). As the COVID-19 surge continues, Atrium Health has a record-breaking number of patients in the intensive care unit (ICU) and on ventilators. Get the most important science stories of the day, free in your inbox. Recently, the effectiveness of CPAP or HFNC compared with conventional oxygen therapy was assessed in the RECOVERY-RS multicentric randomized clinical trial, in 1,273 COVID-19 patients with HARF who were deemed suitable for tracheal intubation if treatment escalation was required20. Funding: The author(s) received no specific funding for this work. Frat, J. P. et al. Respir. In the figure, weeks with suppressed data do not have a corresponding data point on the indicator line. PubMed Higher P/F rations and no difference in inflammatory parameters between deceased and survivors (Tables 2 and 3), suggest less sick patients were intubated. . . Sensitivity analyses included: (1) repeating models excluding patients who changed their initial NIRS treatment during the course of the hospitalization to another NIRS treatment (crossover, n=44); (2) excluding patients with missing measured PaO2/FIO2 (n=123); (3) excluding patients receiving NIRS as ceiling of treatment (n=140); and (4) additionally adjusting models for, one at a time, D-dimer levels, respiratory rate, systemic corticosteroid use and Charlson index. Oxygen therapy for acutely ill medical patients: A clinical practice guideline. Vianello, A. et al. Hammad Zafar, 172, 11121118 (2005). About half of COVID-19 patients on ventilators die, according to a 2021 meta-analysis. J. Respir. Before/after observational study in a mixed intensive care unit (ICU) of a university teaching hospital. 57, 2100048 (2021). Eur. These results were robust to a number of stratified and sensitivity analyses. JAMA 315, 24352441 (2016). Provided by the Springer Nature SharedIt content-sharing initiative. Moreover, NIRS treatment groups exhibited only minor differences which were accounted for in the multivariable and sensitivity analyses thus minimizing the selection bias risk. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Grasselli, G., Pesenti, A. According to current Spanish recommendations8, criteria for initiating respiratory support were moderate to severe dyspnoea, respiratory rate>30bpm, or PaO2/FiO2<200mmHg, screened either at hospital admission or ward admission. The primary outcome was treatment failure, defined as endotracheal intubation or death within 28days of NIRS initiation. Bronconeumol. Article Median age was 66, median body-mass index was 35 kg/m 2, almost all patients had hypertension, and nearly two thirds had diabetes. After exclusion of hospitalized patients, the hospital and MV-related mortality rates were 21.6% and 26.5% respectively. BMJ 369, m1985 (2020). In order to minimize the risks of infection to staff, we applied NIV and CPAP treatments through oronasal or total face non-vented masks attached to single-limb circuits with intentional leak, and placing a low-pressure viral filter preventing exhaled droplet dispersion; in HFNC-treated patients, a surgical mask was put over the nasal prongs8,9. Thorax 75, 9981000 (2020). MORE: Antibody test study results suggest COVID-19 cases likely much higher than reported. and JavaScript. Finally, we cannot rule out the possibility that NIV was tolerated worse than HFNC or CPAP, which would have reduced adherence and lowered the effectiveness of the therapy. Am. The mortality rate among 165 COVID-19 patients placed on a ventilator at Emory was just under 30%. The COVID-19 pandemic has raised concern regarding the capacity to provide care for a surge of critically ill patients that might require excluding patients with a low probability of short-term survival from receiving mechanical ventilation. Care 17, R269 (2013). Rep. 11, 144407 (2021). This alone may explain some of our lower mortality [35]. [ view less ], * E-mail: Eduardo.Oliveira.md@adventhealth.com, Affiliation: Sci. Recovery Collaborative Group et al. Clinical course of COVID-19 patients needing supplemental oxygen outside the intensive care unit, Clinical features and predictors of severity in COVID-19 patients with critical illness in Singapore, Outcome in early vs late intubation among COVID-19 patients with acute respiratory distress syndrome: an updated systematic review and meta-analysis, Nasal intermittent positive pressure ventilation as a rescue therapy after nasal continuous positive airway pressure failure in infants with respiratory distress syndrome, Clinical relevance of timing of assessment of ICU mortality in patients with moderate-to-severe Acute Respiratory Distress Syndrome, https://amhp.org.uk/app/uploads/2020/03/Guidance-Respiratory-Support.pdf, http://creativecommons.org/licenses/by/4.0/. In the stratified analysis of our cohort, planned a priori, patients with a PaO2/FIO2 ratio above 150 responded similarly to HFNC and NIV treatments, suggesting that the severity of the hypoxemia might predict the success of NIV, as previously reported in non-COVID patients4,28,29. Rochwerg, B. et al. The main outcome was intubation or death at 28days after respiratory support initiation. Care 59, 113120 (2014). Given the small number of missing information and that missing were considered at random, we conducted a complete case approach. The overall mortality rate 4 weeks after hospital admission was 24%, with age, acute kidney injury, and respiratory distress as the associated factors. Competing interests: The authors have declared that no competing interests exist. A significant interaction (P<0.001) was found between year and county-level COVID-19 mortality rate, with patients in communities with high (51-100 deaths per 1 000 000) and very high (>100 deaths per 1 000 000) monthly COVID-19 mortality rates experiencing, respectively, 28% and 42% lower survival during the surge period in 2020 as compared . The. However, little is known about the physiologic consequences of the volatile anesthetics when used for long periods in patients who are infected with Covid-19. "Instead of lying on your back, we have you lie on your belly. In the treatment of HARF with CPAP or NIV the interface via which these treatments are applied should be considered, since better outcomes have been reported with a helmet interface than with face masks in non-COVID patients6,35 , possibly due to a greater tolerance of the helmet and a more effective delivery of PEEP36. All analyses were performed using StataCorp. Compare that to the 36% mortality rate of non-COVID patients receiving advanced respiratory support reported to ICNARC from 2017 to 2019. Slider with three articles shown per slide. 202, 10391042 (2020). predicted hospital mortality rates were calculated using the equations of APACHE IVB utilizing principal diagnosis of viral and bacterial pneumonia [20]. A stall in treatment advances for Covid-19 has raised concern among medical experts about unvaccinated people, who still make up half the country, and their likelihood of surviving the coming wave . JAMA 323, 15451546 (2020). Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: A randomized controlled trial. & Pesenti, A. Arch. Yet weeks to months after their infections had cleared, they were. A sample is collected using a swab of your nose, your nose and throat, or your saliva. Study conception and design: S.M., J.S., J.F., J.G.-A. The truth is that 86% of adult COVID-19 patients are ages 18-64, so it's affecting many in our community. Med. Chest 158, 19922002 (2020). Google Scholar. Patient self-inflicted lung injury and positive end-expiratory pressure for safe spontaneous breathing. Obviously, reaching a definitive conclusion on this point will require further studies with better phenotypic characterization of patients, and considering additional factors implicated in the response to therapies such as the interface used or the monitoring of the inspiratory effort. Statistical analysis: A.-E.C., J.G.-A. First, in the Italian study, the mean PaO2/FIO2 ratio was 152mm Hg, suggesting a less severe respiratory failure than in our patients (125mm Hg). Of those alive patients, 88.6% (N = 93) were discharged from the hospital. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Chest 150, 307313 (2016). [Accessed 25 Feb 2020]. Curr. Overall, 24 deaths occurred within 4 weeks of initial hospital admission: 21 were in the hospital, 2 were in the ICU, and 1 was at home after discharge.