Department of Medicine, University of California, Los Angeles, Los Angeles, CA; Barlow Respiratory Hospital, University of California, Los Angeles, Los Angeles, CA.
Department of Medicine, University of California, Los Angeles, Los Angeles, CA; Barlow Respiratory Hospital, University of California, Los Angeles, Los Angeles, CA.
Chest. 2022 Jun;161(6):1517-1525. doi: 10.1016/j.chest.2022.02.030. Epub 2022 Feb 25.
Mechanical ventilation (MV) via tracheostomy is performed commonly for patients who are in long-term acute care hospitals (LTACHs) after respiratory failure. However, the outcome of MV in COVID-19-associated respiratory failure in LTACHs is not known.
What is the ventilator liberation rate of patients who have received tracheostomy with COVID-19-associated respiratory failure compared with those with respiratory failure unrelated to COVID-19 in LTACHs?
In this retrospective cohort study, we examined mechanically ventilated patients discharged between June 2020 and March 2021. Of 242 discharges, 165 patients who had undergone tracheostomy arrived and were considered for ventilator liberation. One hundred twenty-eight patients did not have COVID-19 and 37 patients were admitted for COVID-19.
The primary outcome of the study was ventilator liberation; secondary outcomes were functional recovery, length of stay (LOS) at the LTACH, and discharge disposition. After controlling for demographics, the number of comorbidities, hemodialysis, vasopressor need, thrombocytopenia, and the LOS at the short-term acute care hospital, our results indicated that patients with COVID-19 showed a higher adjusted ventilator liberation rate of 91.4% vs 56.0% in those without COVID-19. Functional ability was assessed with the change of Functional Status Score for the Intensive Care Unit (FSS-ICU) between admission and discharge. The adjusted mean change in FSS-ICU was significantly higher in the COVID-19 group than in the non-COVID-19 group: 9.49 (95% CI, 7.38-11.6) vs 2.08 (95% CI, 1.05-3.11), respectively (P < .001). Patients with COVID-19 experienced a shorter adjusted LOS at the LTACH with an adjusted hazard ratio of 1.57 (95% CI, 1.0-2.46; P = .05) compared with patients without COVID-19. We did not observe significant differences between the two groups regarding discharge location, but a trend toward need for lower level of care was found in patients with COVID-19.
Our study suggests that patients with COVID-19 requiring MV and tracheostomy have a higher chance for recovery than those without COVID-19.
在长期急性护理医院（LTACH）中，因呼吸衰竭而进行机械通气（MV）并通过气管切开术进行治疗的患者较为常见。然而，在 LTACH 中，与 COVID-19 相关的呼吸衰竭患者接受 MV 的结果尚不清楚。
与非 COVID-19 相关的呼吸衰竭患者相比，患有 COVID-19 相关呼吸衰竭并接受气管切开术的患者的呼吸机撤离率是多少？
在这项回顾性队列研究中，我们检查了 2020 年 6 月至 2021 年 3 月间出院的机械通气患者。在 242 次出院中，有 165 名接受气管切开术的患者到达并被认为可以进行呼吸机撤离。128 名患者没有 COVID-19，37 名患者因 COVID-19 入院。
该研究的主要结局为呼吸机撤离；次要结局为功能恢复、LTACH 住院时间（LOS）和出院去向。在控制人口统计学、合并症数量、血液透析、血管加压素需求、血小板减少症和短期急性护理医院的 LOS 后，我们的结果表明，COVID-19 患者的调整后呼吸机撤离率更高，为 91.4%，而非 COVID-19 患者为 56.0%。通过 ICU 功能状态评分（FSS-ICU）在入院和出院之间的变化来评估功能能力。COVID-19 组的调整后 FSS-ICU 平均变化明显高于非 COVID-19 组：9.49（95%CI，7.38-11.6）vs.2.08（95%CI，1.05-3.11）（P<.001）。与非 COVID-19 患者相比，COVID-19 患者的 LTACH 调整后 LOS 更短，调整后风险比为 1.57（95%CI，1.0-2.46；P=.05）。两组在出院去向方面没有观察到显著差异，但 COVID-19 患者对较低水平护理的需求呈趋势。
我们的研究表明，需要 MV 和气管切开术的 COVID-19 患者比没有 COVID-19 的患者更有可能康复。
