12300Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
205134Jack D Weiler Hospital of the Albert Einstein College of Medicine Emergency Room, Bronx, NY, USA.
J Intensive Care Med. 2021 Oct;36(10):1209-1216. doi: 10.1177/08850666211033836. Epub 2021 Aug 16.
Respiratory failure due to coronavirus disease of 2019 (COVID-19) often presents with worsening gas exchange over a period of days. Once patients require mechanical ventilation (MV), the temporal change in gas exchange and its relation to clinical outcome is poorly described. We investigated whether gas exchange over the first 5 days of MV is associated with mortality and ventilator-free days at 28 days in COVID-19. In a cohort of 294 COVID-19 patients, we used data during the first 5 days of MV to calculate 4 daily respiratory scores: PaO/FiO (P/F), oxygenation index (OI), ventilatory ratio (VR), and Murray lung injury score. The association between these scores at early (days 1-3) and late (days 4-5) time points with mortality was evaluated using logistic regression, adjusted for demographics. Correlation with ventilator-free days was assessed (Spearman rank-order coefficients). Overall mortality was 47.6%. Nonsurvivors were older ( < .0001), more male ( = .029), with more preexisting cardiopulmonary disease compared to survivors. Mean PaO and PaCO were similar during this timeframe. However, by days 4 to 5 values for all airway pressures and FiO had diverged, trending lower in survivors and higher in nonsurvivors. The most substantial between-group difference was the temporal change in OI, improving 15% in survivors and worsening 11% in nonsurvivors ( < .05). The adjusted mortality OR was significant for age (1.819, = .001), OI at days 4 to 5 (2.26, = .002), and OI percent change (1.90, = .02). The number of ventilator-free days correlated significantly with late VR (-0.166, < .05), early and late OI (-0.216, < .01; -0.278, < .01, respectively) and early and late P/F (0.158, < .05; 0.283, < .01, respectively). Nonsurvivors of COVID-19 needed increasing intensity of MV to sustain gas exchange over the first 5 days, unlike survivors. Temporal change OI, reflecting both PaO and the intensity of MV, is a potential marker of outcome in respiratory failure due to COVID-19.
由于 2019 年冠状病毒病（COVID-19）导致的呼吸衰竭通常在数天内出现气体交换恶化。一旦患者需要机械通气（MV），气体交换的时间变化及其与临床结果的关系就描述得很差。我们研究了 MV 治疗的前 5 天内的气体交换是否与 COVID-19 患者的死亡率和 28 天无呼吸机天数有关。在 294 例 COVID-19 患者的队列中，我们使用 MV 治疗的前 5 天内的数据来计算 4 个每日呼吸评分：PaO/FiO（P/F）、氧合指数（OI）、通气比（VR）和 Murray 肺损伤评分。使用逻辑回归评估早期（第 1-3 天）和晚期（第 4-5 天）时间点这些评分与死亡率之间的关系，并进行了人口统计学调整。使用 Spearman 等级相关系数评估与无呼吸机天数的相关性。总体死亡率为 47.6%。与幸存者相比，非幸存者年龄更大（ < .0001），男性更多（ = .029），并且有更多的心肺疾病史。在此时间范围内，平均 PaO 和 PaCO 相似。然而，到第 4 至 5 天，所有气道压力和 FiO 的数值都出现了分歧，幸存者的数值趋于降低，而非幸存者的数值趋于升高。组间差异最大的是 OI 的时间变化，幸存者改善了 15%，而非幸存者恶化了 11%（ < .05）。年龄（1.819， = .001）、第 4-5 天的 OI（2.26， = .002）和 OI 百分比变化（1.90， = .02）的调整死亡率 OR 具有统计学意义。无呼吸机天数与晚期 VR（-0.166， < .05）、早期和晚期 OI（-0.216， < .01；-0.278， < .01）以及早期和晚期 P/F（0.158， < .05；0.283， < .01）显著相关。与幸存者不同，COVID-19 非幸存者需要增加 MV 的强度才能维持前 5 天的气体交换。非幸存者的气体交换恶化，而幸存者的气体交换改善。反映 PaO 和 MV 强度的时间变化 OI 可能是 COVID-19 呼吸衰竭患者预后的潜在标志物。
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