Abbott Northwestern Hospital, Minneapolis, MN 55407-3799, USA.
Abbott Northwestern Hospital, Minneapolis, MN, USA.
Ther Adv Respir Dis. 2022 Jan-Dec;16:17534666221086415. doi: 10.1177/17534666221086415.
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.
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.
Of 355 patients studied, 86 (24%) required PMV. PMV patients had lower PaO/FiO ratio, higher PCO, 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 < 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/FiO 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.
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/FiO ratio, lower plateau pressure, and fewer comorbidities appear to be associated with survival in this group.
新冠肺炎（COVID-19）患者的机械通气（MV）与高死亡率和广泛的资源利用有关。本研究旨在探讨与 COVID-19 患者长时间机械通气（PMV）相关的预后因素和结局。
这是一项回顾性队列研究，纳入了 2020 年 3 月 1 日至 2021 年 6 月 30 日期间在隶属于单一医疗系统的三家转诊医院的重症监护病房（ICU）中接受有创 MV 的 COVID-19 患者。数据从电子病历中提取。PMV 的定义为 MV 时间超过 17 天。
在 355 名研究患者中，86 名（24%）需要 PMV。PMV 患者在 MV 的前 2 周内的 PaO/FiO 比值较低，PCO 较高，平台压和驱动压较高，与短 MV（ ⩽ 17 天）患者相比。PMV 患者接受了更多的俯卧位通气、神经肌肉阻滞剂和气管切开术，ICU 和住院时间较长，更频繁地需要出院到住院康复设施（均 < 0.001）。总体 30 天死亡率为 43.9%，PMV 和 SMV 组之间无统计学差异。在 PMV 患者中，吸烟、Charlson 合并症指数 > 6、第 2 周 PaO/FiO 比值 < 150 和平台压 ⩾ 30 与 30 天死亡率呈正相关。在多变量模型中，结果与单变量分析方向一致，但未达到统计学意义。
COVID-19 呼吸衰竭患者通常需要 PMV。尽管需要更多的重症监护干预和 LOS，但 PMV 队列中超过一半的患者存活至出院。较高的 PaO/FiO 比值、较低的平台压和较少的合并症似乎与该组患者的生存相关。
