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