National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China.
Crit Care Med. 2020 Sep;48(9):e809-e812. doi: 10.1097/CCM.0000000000004473.
The outbreak of coronavirus disease 2019 is becoming a worldwide pandemic. Mechanical ventilation is lifesaving for respiratory distress, this study was designed to delineate the clinical features of the coronavirus disease 2019 patients with mechanical ventilation from a national cohort in China.
Prospective observational study.
The rapid spread of severe acute respiratory syndrome coronavirus 2 has infected more than 7.7 million people and caused more than 423,000 deaths.
Adult hospitalized coronavirus disease 2019 patients with mechanical ventilation from 557 hospitals from China.
None.
From a nationwide cohort, 141 coronavirus disease 2019 cases with mechanical ventilation were extracted from 1,590 cases. Cigarette smoke, advanced age, coexisting chronic illness, elevated systolic blood pressure, high body temperature, and abnormal laboratory findings are common in these ventilated cases. Multivariate regression analysis showed that higher odds of in-hospital death was associated with invasive mechanical ventilation requirement (hazard ratio: 2.95; 95% CI, 1.40-6.23; p = 0.005), and coexisting chronic obstructive pulmonary disease (hazard ratio, 4.57; 95% CI, 1.65-12.69; p = 0.004) and chronic renal disease (hazard ratio, 5.45; 95% CI, 1.85-16.12; p = 0.002). Compared with patients with noninvasive mechanical ventilation, patients who needs invasive mechanical ventilation showed higher rate of elevated D-dimer (> 1.5 mg/L) at admission (hazard ratio, 3.28, 95% CI, 1.07-10.10; p = 0.039).
The potential risk factors of elevated D-dimer level could help clinicians to identify invasive mechanical ventilation requirement at an early stage, and coexisting chronic obstructive pulmonary disease or chronic renal disease are independent risk factors associated with fatal outcome in coronavirus disease 2019 patients with mechanical ventilation.
2019 年冠状病毒病的爆发正在成为全球大流行。机械通气是治疗呼吸窘迫的救命方法，本研究旨在描述中国全国队列中接受机械通气的 2019 年冠状病毒病患者的临床特征。
前瞻性观察性研究。
严重急性呼吸综合征冠状病毒 2 的迅速传播已感染了超过 770 万人，并导致超过 42.3 万人死亡。
来自中国 557 家医院的因 2019 年冠状病毒病住院并接受机械通气的成年患者。
无。
从全国范围内的队列中，从 1590 例患者中提取了 141 例 2019 年冠状病毒病机械通气病例。吸烟、高龄、并存的慢性疾病、收缩压升高、高热和异常实验室发现常见于这些需要通气的病例中。多变量回归分析显示，住院死亡的可能性更高与有创机械通气需求相关（危险比：2.95；95%置信区间，1.40-6.23；p = 0.005），并存的慢性阻塞性肺疾病（危险比，4.57；95%置信区间，1.65-12.69；p = 0.004）和慢性肾脏病（危险比，5.45；95%置信区间，1.85-16.12；p = 0.002）。与接受无创机械通气的患者相比，需要有创机械通气的患者在入院时 D-二聚体升高（危险比，3.28；95%置信区间，1.07-10.10；p = 0.039）的发生率更高。
升高的 D-二聚体水平的潜在危险因素可以帮助临床医生在早期识别有创机械通气的需求，并存的慢性阻塞性肺疾病或慢性肾脏病是与接受机械通气的 2019 年冠状病毒病患者致命结局相关的独立危险因素。
