Difference between initial ventilation strategies in patients seen in the emergency department during the first and second waves of the COVID-19 pandemic

Objective: COVID-19 infection has led to changes in known treatment strategies, mainly with respect to its critical form, that is, the presentation of acute respiratory distress syndrome, which requires the use of mechanical ventilation. Methods: Ventilation strategies were compared between the first and second wave of patients with COVID-19 who were treated in the emergency department and who required endotracheal intubation. Results: Of the 62 patients treated in the emergency department, invasive mechanical ventilation was started in the second group 7.9 hours earlier than in the first group (95% CI: –11.65 to –4.19; p < 0.001). The use of prone position was greater up to 50% in the second group (95% CI: 0.17-0.85; p = 0.009). The second group used 3 cmH2O less PEEP (95% CI: –4.17 to –1.87; p < 0.001). Conclusions: Changes in ventilation strategies were evident in patients with severe COVID-19. Although they did not show a significant difference, it can be inferred that 28-day mortality in the second group decreased due to the change in the use of PEEP, early intubation, and prone position.