tetano
Editor, Senior Moderator
Ther Adv Respir Dis
. Jan-Dec 2022;16:17534666221086415.
doi: 10.1177/17534666221086415.
Prognostic factors and outcomes in COVID-19 patients requiring prolonged mechanical ventilation: a retrospective cohort study
Roman Melamed[SUP] 1 [/SUP], Francisco Paz[SUP] 2 [/SUP], Stacy Jepsen[SUP] 2 [/SUP], Claire Smith[SUP] 3 [/SUP], Ramiro Saavedra[SUP] 2 [/SUP], Maximilian Mulder[SUP] 2 [/SUP], Adnan Masood[SUP] 2 [/SUP], Joshua Huelster[SUP] 2 [/SUP], Lisa Kirkland[SUP] 2 [/SUP], Alena Guenther[SUP] 3 [/SUP], Lori Boland[SUP] 3 [/SUP]
Affiliations
Abstract
Background: Mechanical ventilation (MV) in coronavirus disease 2019 (COVID-19) patients is associated with high mortality and extensive resource utilization. The aim of this study was to investigate prognostic factors and outcomes associated with prolonged mechanical ventilation (PMV) in COVID-19 patients.
Methods: This was a retrospective cohort study of COVID-19 patients requiring invasive MV who were hospitalized between 1 March 2020 and 30 June 2021 in the intensive care units (ICUs) of three referral hospitals belonging to a single health system. Data were extracted from electronic health records. PMV was defined as > 17 days of MV.
Results: Of 355 patients studied, 86 (24%) required PMV. PMV patients had lower PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio, higher PCO[SUB]2[/SUB], and higher plateau and driving pressures during the first 2 weeks of MV than their short MV (SMV; ⩽ 17 days) counterparts. PMV patients received more proning, neuromuscular blockade, and tracheostomy, had longer ICU and hospital length of stay (LOS), and required discharge to an inpatient rehabilitation facility more frequently (all p < 0.001). Overall 30-day mortality was 43.9%, with no statistically significant difference between PMV and SMV groups. In PMV patients, smoking, Charlson comorbidity index > 6, and week 2 PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio < 150 and plateau pressure ⩾ 30 were positively associated with 30-day mortality. In a multivariate model, results were directionally consistent with the univariate analysis but did not reach statistical significance.
Conclusion: PMV is commonly required in COVID-19 patients with respiratory failure. Despite the higher need for critical care interventions and LOS, more than half of the PMV cohort survived to hospital discharge. Higher PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio, lower plateau pressure, and fewer comorbidities appear to be associated with survival in this group.
Keywords: COVID-19 virus disease; intensive care units; length of stay; mechanical ventilation; respiratory failure.
. Jan-Dec 2022;16:17534666221086415.
doi: 10.1177/17534666221086415.
Prognostic factors and outcomes in COVID-19 patients requiring prolonged mechanical ventilation: a retrospective cohort study
Roman Melamed[SUP] 1 [/SUP], Francisco Paz[SUP] 2 [/SUP], Stacy Jepsen[SUP] 2 [/SUP], Claire Smith[SUP] 3 [/SUP], Ramiro Saavedra[SUP] 2 [/SUP], Maximilian Mulder[SUP] 2 [/SUP], Adnan Masood[SUP] 2 [/SUP], Joshua Huelster[SUP] 2 [/SUP], Lisa Kirkland[SUP] 2 [/SUP], Alena Guenther[SUP] 3 [/SUP], Lori Boland[SUP] 3 [/SUP]
Affiliations
- PMID: 35311403
- DOI: 10.1177/17534666221086415
Abstract
Background: Mechanical ventilation (MV) in coronavirus disease 2019 (COVID-19) patients is associated with high mortality and extensive resource utilization. The aim of this study was to investigate prognostic factors and outcomes associated with prolonged mechanical ventilation (PMV) in COVID-19 patients.
Methods: This was a retrospective cohort study of COVID-19 patients requiring invasive MV who were hospitalized between 1 March 2020 and 30 June 2021 in the intensive care units (ICUs) of three referral hospitals belonging to a single health system. Data were extracted from electronic health records. PMV was defined as > 17 days of MV.
Results: Of 355 patients studied, 86 (24%) required PMV. PMV patients had lower PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio, higher PCO[SUB]2[/SUB], and higher plateau and driving pressures during the first 2 weeks of MV than their short MV (SMV; ⩽ 17 days) counterparts. PMV patients received more proning, neuromuscular blockade, and tracheostomy, had longer ICU and hospital length of stay (LOS), and required discharge to an inpatient rehabilitation facility more frequently (all p < 0.001). Overall 30-day mortality was 43.9%, with no statistically significant difference between PMV and SMV groups. In PMV patients, smoking, Charlson comorbidity index > 6, and week 2 PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio < 150 and plateau pressure ⩾ 30 were positively associated with 30-day mortality. In a multivariate model, results were directionally consistent with the univariate analysis but did not reach statistical significance.
Conclusion: PMV is commonly required in COVID-19 patients with respiratory failure. Despite the higher need for critical care interventions and LOS, more than half of the PMV cohort survived to hospital discharge. Higher PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio, lower plateau pressure, and fewer comorbidities appear to be associated with survival in this group.
Keywords: COVID-19 virus disease; intensive care units; length of stay; mechanical ventilation; respiratory failure.