Ann Intensive Care . Long-term survival of mechanically ventilated patients with severe COVID-19: an observational cohort study

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Ann Intensive Care


. 2021 Oct 2;11(1):143.
doi: 10.1186/s13613-021-00929-y.
Long-term survival of mechanically ventilated patients with severe COVID-19: an observational cohort study


Oscar Peñuelas ^{1 2} , Laura Del Campo-Albendea ³ , Amanda Lesmes González de Aledo ⁴ , José Manuel Añón ^{5 6} , Carmen Rodríguez-Solís ⁷ , Jordi Mancebo ⁸ , Paula Vera ⁸ , Daniel Ballesteros ⁹ , Jorge Jiménez ⁷ , Emilio Maseda ¹⁰ , Juan Carlos Figueira ^{5 6} , Nieves Franco ¹¹ , Ángela Algaba ¹² , Juan Pablo Avilés ¹³ , Ricardo Díaz ¹³ , Beatriz Abad ¹⁴ , Alfonso Canabal ¹⁴ , Ana Abella ¹⁵ , Federico Gordo ¹⁵ , Javier García ¹⁶ , Jessica García Suarez ¹⁶ , Jamil Cedeño ¹⁷ , Basilia Martínez-Palacios ¹⁸ , Eva Manteiga ¹⁸ , Óscar Martínez ¹⁹ , Rafael Blancas ¹⁹ , Tommaso Bardi ²⁰ , David Pestaña ²⁰ , José Ángel Lorente ^{7 5} , Alfonso Muriel ³ , Andrés Esteban ⁷ , Fernando Frutos-Vivar ⁷



Affiliations

• PMID: 34601646
• DOI: 10.1186/s13613-021-00929-y

Abstract

Background: Information is lacking regarding long-term survival and predictive factors for mortality in patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) and undergoing invasive mechanical ventilation. We aimed to estimate 180-day mortality of patients with COVID-19 requiring invasive ventilation, and to develop a predictive model for long-term mortality.
Methods: Retrospective, multicentre, national cohort study between March 8 and April 30, 2020 in 16 intensive care units (ICU) in Spain. Participants were consecutive adults who received invasive mechanical ventilation for COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection detected in positive testing of a nasopharyngeal sample and confirmed by real time reverse-transcriptase polymerase chain reaction (rt-PCR). The primary outcomes was 180-day survival after hospital admission. Secondary outcomes were length of ICU and hospital stay, and ICU and in-hospital mortality. A predictive model was developed to estimate the probability of 180-day mortality.
Results: 868 patients were included (median age, 64 years [interquartile range [IQR], 56-71 years]; 72% male). Severity at ICU admission, estimated by SAPS3, was 56 points [IQR 50-63]. Prior to intubation, 26% received some type of noninvasive respiratory support. The unadjusted overall 180-day survival rates was 59% (95% CI 56-62%). The predictive factors measured during ICU stay, and associated with 180-day mortality were: age [Odds Ratio [OR] per 1-year increase 1.051, 95% CI 1.033-1.068)), SAPS3 (OR per 1-point increase 1.027, 95% CI 1.011-1.044), diabetes (OR 1.546, 95% CI 1.085-2.204), neutrophils to lymphocytes ratio (OR per 1-unit increase 1.008, 95% CI 1.001-1.016), failed attempt of noninvasive positive pressure ventilation prior to orotracheal intubation (OR 1.878 (95% CI 1.124-3.140), use of selective digestive decontamination strategy during ICU stay (OR 0.590 (95% CI 0.358-0.972) and administration of low dosage of corticosteroids (methylprednisolone 1 mg/kg) (OR 2.042 (95% CI 1.205-3.460).
Conclusion: The long-term survival of mechanically ventilated patients with severe COVID-19 reaches more than 50% and may help to provide individualized risk stratification and potential treatments.
Trial registration: ClinicalTrials.gov Identifier: NCT04379258. Registered 10 April 2020 (retrospectively registered).

Keywords: ARDS; COVID-19; Coronavirus disease 2019; Intensive care unit; Invasive mechanical ventilation; Mortality; Noninvasive ventilation; Pneumonia; SARS-CoV-2.