tetano
Editor, Senior Moderator
Crit Care Explor
. 2021 Nov 5;3(11):e0567.
doi: 10.1097/CCE.0000000000000567. eCollection 2021 Nov.
Assessment of 28-Day In-Hospital Mortality in Mechanically Ventilated Patients With Coronavirus Disease 2019: An International Cohort Study
Gianluigi Li Bassi[SUP] 1 2 3 4 5 [/SUP], Jacky Y Suen[SUP] 1 2 [/SUP], Nicole White[SUP] 6 [/SUP], Heidi J Dalton[SUP] 7 [/SUP], Jonathon Fanning[SUP] 1 2 5 8 [/SUP], Amanda Corley[SUP] 1 2 [/SUP], Sally Shrapnel[SUP] 2 9 [/SUP], Samuel Hinton[SUP] 2 [/SUP], Simon Forsyth[SUP] 2 [/SUP], Rex Parsons[SUP] 6 [/SUP], John G Laffey[SUP] 10 11 [/SUP], Eddy Fan[SUP] 12 [/SUP], Robert Bartlett[SUP] 13 [/SUP], Daniel Brodie[SUP] 14 [/SUP], Aidan Burrell[SUP] 15 16 [/SUP], Davide Chiumello[SUP] 17 18 [/SUP], Alyaa Elhazmi[SUP] 19 [/SUP], Giacomo Grasselli[SUP] 18 20 [/SUP], Carol Hodgson[SUP] 21 [/SUP], Shingo Ichiba[SUP] 22 [/SUP], Carlos Luna[SUP] 23 [/SUP], Eva Marwali[SUP] 24 [/SUP], Laura Merson[SUP] 25 [/SUP], Srinivas Murthy[SUP] 26 [/SUP], Alistair Nichol[SUP] 21 27 [/SUP], Mauro Panigada[SUP] 20 [/SUP], Paolo Pelosi[SUP] 28 29 [/SUP], Antoni Torres[SUP] 3 30 [/SUP], Pauline Yeung Ng[SUP] 31 [/SUP], Mark Ogino[SUP] 32 [/SUP], John F Fraser[SUP] 1 2 3 4 5 [/SUP]
Affiliations
Abstract
Factors associated with mortality in coronavirus disease 2019 patients on invasive mechanical ventilation are still not fully elucidated.
Objectives: To identify patient-level parameters, readily available at the bedside, associated with the risk of in-hospital mortality within 28 days from commencement of invasive mechanical ventilation or coronavirus disease 2019.
Design setting and participants: Prospective observational cohort study by the global Coronavirus Disease 2019 Critical Care Consortium. Patients with laboratory-confirmed coronavirus disease 2019 requiring invasive mechanical ventilation from February 2, 2020, to May 15, 2021.
Main outcomes and measures: Patient characteristics and clinical data were assessed upon ICU admission, the commencement of invasive mechanical ventilation and for 28 days thereafter. We primarily aimed to identify time-independent and time-dependent risk factors for 28-day invasive mechanical ventilation mortality.
Results: One-thousand five-hundred eighty-seven patients were included in the survival analysis; 588 patients died in hospital within 28 days of commencing invasive mechanical ventilation (37%). Cox-regression analysis identified associations between the hazard of 28-day invasive mechanical ventilation mortality with age (hazard ratio, 1.26 per 10-yr increase in age; 95% CI, 1.16-1.37; p < 0.001), positive end-expiratory pressure upon commencement of invasive mechanical ventilation (hazard ratio, 0.81 per 5 cm H[SUB]2[/SUB]O increase; 95% CI, 0.67-0.97; p = 0.02). Time-dependent parameters associated with 28-day invasive mechanical ventilation mortality were serum creatinine (hazard ratio, 1.28 per doubling; 95% CI, 1.15-1.41; p < 0.001), lactate (hazard ratio, 1.22 per doubling; 95% CI, 1.11-1.34; p < 0.001), Paco[SUB]2[/SUB] (hazard ratio, 1.63 per doubling; 95% CI, 1.19-2.25; p < 0.001), pH (hazard ratio, 0.89 per 0.1 increase; 95% CI, 0.8-14; p = 0.041), Pao[SUB]2[/SUB]/Fio[SUB]2[/SUB] (hazard ratio, 0.58 per doubling; 95% CI, 0.52-0.66; p < 0.001), and mean arterial pressure (hazard ratio, 0.92 per 10 mm Hg increase; 95% CI, 0.88-0.97; p = 0.003).
Conclusions and relevance: This international study suggests that in patients with coronavirus disease 2019 on invasive mechanical ventilation, older age and clinically relevant variables monitored at baseline or sequentially during the course of invasive mechanical ventilation are associated with 28-day invasive mechanical ventilation mortality hazard. Further investigation is warranted to validate any causative roles these parameters might play in influencing clinical outcomes.
Keywords: coronavirus disease 2019; intensive care unit; mechanical ventilation; severe acute respiratory syndrome coronavirus 2.
. 2021 Nov 5;3(11):e0567.
doi: 10.1097/CCE.0000000000000567. eCollection 2021 Nov.
Assessment of 28-Day In-Hospital Mortality in Mechanically Ventilated Patients With Coronavirus Disease 2019: An International Cohort Study
Gianluigi Li Bassi[SUP] 1 2 3 4 5 [/SUP], Jacky Y Suen[SUP] 1 2 [/SUP], Nicole White[SUP] 6 [/SUP], Heidi J Dalton[SUP] 7 [/SUP], Jonathon Fanning[SUP] 1 2 5 8 [/SUP], Amanda Corley[SUP] 1 2 [/SUP], Sally Shrapnel[SUP] 2 9 [/SUP], Samuel Hinton[SUP] 2 [/SUP], Simon Forsyth[SUP] 2 [/SUP], Rex Parsons[SUP] 6 [/SUP], John G Laffey[SUP] 10 11 [/SUP], Eddy Fan[SUP] 12 [/SUP], Robert Bartlett[SUP] 13 [/SUP], Daniel Brodie[SUP] 14 [/SUP], Aidan Burrell[SUP] 15 16 [/SUP], Davide Chiumello[SUP] 17 18 [/SUP], Alyaa Elhazmi[SUP] 19 [/SUP], Giacomo Grasselli[SUP] 18 20 [/SUP], Carol Hodgson[SUP] 21 [/SUP], Shingo Ichiba[SUP] 22 [/SUP], Carlos Luna[SUP] 23 [/SUP], Eva Marwali[SUP] 24 [/SUP], Laura Merson[SUP] 25 [/SUP], Srinivas Murthy[SUP] 26 [/SUP], Alistair Nichol[SUP] 21 27 [/SUP], Mauro Panigada[SUP] 20 [/SUP], Paolo Pelosi[SUP] 28 29 [/SUP], Antoni Torres[SUP] 3 30 [/SUP], Pauline Yeung Ng[SUP] 31 [/SUP], Mark Ogino[SUP] 32 [/SUP], John F Fraser[SUP] 1 2 3 4 5 [/SUP]
Affiliations
- PMID: 34765979
- PMCID: PMC8575423
- DOI: 10.1097/CCE.0000000000000567
Abstract
Factors associated with mortality in coronavirus disease 2019 patients on invasive mechanical ventilation are still not fully elucidated.
Objectives: To identify patient-level parameters, readily available at the bedside, associated with the risk of in-hospital mortality within 28 days from commencement of invasive mechanical ventilation or coronavirus disease 2019.
Design setting and participants: Prospective observational cohort study by the global Coronavirus Disease 2019 Critical Care Consortium. Patients with laboratory-confirmed coronavirus disease 2019 requiring invasive mechanical ventilation from February 2, 2020, to May 15, 2021.
Main outcomes and measures: Patient characteristics and clinical data were assessed upon ICU admission, the commencement of invasive mechanical ventilation and for 28 days thereafter. We primarily aimed to identify time-independent and time-dependent risk factors for 28-day invasive mechanical ventilation mortality.
Results: One-thousand five-hundred eighty-seven patients were included in the survival analysis; 588 patients died in hospital within 28 days of commencing invasive mechanical ventilation (37%). Cox-regression analysis identified associations between the hazard of 28-day invasive mechanical ventilation mortality with age (hazard ratio, 1.26 per 10-yr increase in age; 95% CI, 1.16-1.37; p < 0.001), positive end-expiratory pressure upon commencement of invasive mechanical ventilation (hazard ratio, 0.81 per 5 cm H[SUB]2[/SUB]O increase; 95% CI, 0.67-0.97; p = 0.02). Time-dependent parameters associated with 28-day invasive mechanical ventilation mortality were serum creatinine (hazard ratio, 1.28 per doubling; 95% CI, 1.15-1.41; p < 0.001), lactate (hazard ratio, 1.22 per doubling; 95% CI, 1.11-1.34; p < 0.001), Paco[SUB]2[/SUB] (hazard ratio, 1.63 per doubling; 95% CI, 1.19-2.25; p < 0.001), pH (hazard ratio, 0.89 per 0.1 increase; 95% CI, 0.8-14; p = 0.041), Pao[SUB]2[/SUB]/Fio[SUB]2[/SUB] (hazard ratio, 0.58 per doubling; 95% CI, 0.52-0.66; p < 0.001), and mean arterial pressure (hazard ratio, 0.92 per 10 mm Hg increase; 95% CI, 0.88-0.97; p = 0.003).
Conclusions and relevance: This international study suggests that in patients with coronavirus disease 2019 on invasive mechanical ventilation, older age and clinically relevant variables monitored at baseline or sequentially during the course of invasive mechanical ventilation are associated with 28-day invasive mechanical ventilation mortality hazard. Further investigation is warranted to validate any causative roles these parameters might play in influencing clinical outcomes.
Keywords: coronavirus disease 2019; intensive care unit; mechanical ventilation; severe acute respiratory syndrome coronavirus 2.