Department of Emergency and Critical Care Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China.
Eur Rev Med Pharmacol Sci. 2020 Dec;24(24):13065-13071. doi: 10.26355/eurrev_202012_24214.
Whether patients with COVID-19 require invasive mechanical ventilation (MV) is not yet clear. This article summarizes the clinical treatment process and clinical data of patients with COVID-19 and analyzes the predictive factors for mechanical ventilation for these patients.
A retrospective study was carried out from January 5, 2020, to March 23, 2020, including 98 patients with COVID-19 treated at three designated hospitals in Huangshi City, Hubei Province. Data collection included demographics, previous underlying diseases, clinical manifestations, laboratory examinations, imaging examination results, diagnosis, and prognosis. This study presents a summary of the patients' overall clinical characteristics and clarifies the predictive factors for MV in patients with COVID-19.
There were 56 males and 42 females included in this study. The mortality rate was 26.53% (26/98). Fever, cough, and chest tightness were the most common symptoms (64.3%, 37.8%, and 12.2%, respectively). Thirty cases required MV, 30.61% of the total cases, and the mortality rate was 73.33%. The univariate comparison showed that dyspnea, acute physiologic assessment, chronic health evaluation (APACHE II) score, and the ratio between arterial blood oxygen partial pressure (PaO2) and oxygen concentration (FiO2) (P/F) were statistically different between the MV group and the non-MV group (p < 0.05).
Results showed the following: dyspnea; increased white blood cell count; decreased platelets; lowered albumin levels; increased urea nitrogen; increased levels of myocardial enzymes Creatine Kinase (CK), Creatine Kinase, MB Form (CKMB) and lactate dehydrogenase (LDH); increased lactate, and lowered blood calcium tests. These findings may indicate that the patients have an increased probability of needing MV support. A cutoff value for the initial APACHE II score of >11.5 and the initial PaO2/FiO2 ratio of <122.17 mmHg should be considered for MV support for patients with COVID-19.
目前尚不清楚 COVID-19 患者是否需要有创机械通气（MV）。本文总结了 COVID-19 患者的临床治疗过程和临床数据，并分析了这些患者接受机械通气的预测因素。
回顾性研究时间为 2020 年 1 月 5 日至 3 月 23 日，纳入湖北省黄石市 3 家指定医院收治的 98 例 COVID-19 患者。数据收集包括人口统计学、既往基础疾病、临床表现、实验室检查、影像学检查结果、诊断和预后。本研究总结了患者的整体临床特征，并明确了 COVID-19 患者 MV 的预测因素。
本研究共纳入 56 例男性和 42 例女性。死亡率为 26.53%（26/98）。发热、咳嗽和胸闷是最常见的症状（分别为 64.3%、37.8%和 12.2%）。30 例需要 MV，占总病例数的 30.61%，死亡率为 73.33%。单因素比较显示，MV 组和非 MV 组的呼吸困难、急性生理和慢性健康评估（APACHE II）评分以及动脉血氧分压（PaO2）与氧浓度（FiO2）比值（P/F）差异有统计学意义（p<0.05）。
研究结果表明：呼吸困难；白细胞计数升高；血小板计数降低；白蛋白水平降低；尿素氮升高；心肌酶肌酸激酶（CK）、肌酸激酶同工酶（CKMB）和乳酸脱氢酶（LDH）水平升高；乳酸升高，血钙降低。这些发现可能表明患者需要 MV 支持的可能性增加。对于 COVID-19 患者，初始 APACHE II 评分>11.5 和初始 PaO2/FiO2 比值<122.17mmHg 应考虑进行 MV 支持。
