Divison of Pulmonary and Critical Care Medicine, Weill Cornell Department of Medicine, NY, NY, United States of America.
Division of General Internal Medicine, Weill Cornell Department of Medicine, NY, NY, United States of America.
J Crit Care. 2022 Aug;70:154045. doi: 10.1016/j.jcrc.2022.154045. Epub 2022 Apr 28.
Prolonged observation could avoid invasive mechanical ventilation (IMV) and related risks in patients with Covid-19 acute respiratory failure (ARF) compared to initiating early IMV. We aimed to determine the association between ARF management strategy and in-hospital mortality.
Patients in the Weill Cornell Covid-19 registry who developed ARF between March 5 - March 25, 2020 were exposed to an early IMV strategy; between March 26 - April 1, 2020 to an intermediate strategy; and after April 2 to prolonged observation. Cox proportional hazards regression was used to model in-hospital mortality and test an interaction between ARF management strategy and modified sequential organ failure assessment (mSOFA).
Among 632 patients with ARF, 24% of patients in the early IMV strategy died versus 28% in prolonged observation. At lower mSOFA, prolonged observation was associated with lower mortality compared to early IMV (at mSOFA = 0, HR 0.16 [95% CI 0.04-0.57]). Mortality risk increased in the prolonged observation strategy group with each point increase in mSOFA score (HR 1.29 [95% CI 1.10-1.51], p = 0.002).
In Covid-19 ARF, prolonged observation was associated with a mortality benefit at lower mSOFA scores, and increased mortality at higher mSOFA scores compared to early IMV.
与早期启动有创机械通气（IMV）相比，对新冠病毒急性呼吸衰竭（ARF）患者进行长时间观察可能避免 IMV 及相关风险。我们旨在确定 ARF 管理策略与院内死亡率之间的关系。
Weill Cornell 新冠病毒登记处中于 2020 年 3 月 5 日至 3 月 25 日期间发生 ARF 的患者采用早期 IMV 策略；2020 年 3 月 26 日至 4 月 1 日期间采用中期策略；4 月 2 日之后采用长时间观察。采用 Cox 比例风险回归模型对院内死亡率进行建模，并对 ARF 管理策略与改良序贯器官衰竭评估（mSOFA）之间的相互作用进行检验。
在 632 例 ARF 患者中，早期 IMV 策略组有 24%的患者死亡，而长时间观察组有 28%的患者死亡。mSOFA 较低时，与早期 IMV 相比，长时间观察与较低的死亡率相关（mSOFA = 0 时，HR 0.16 [95% CI 0.04-0.57]）。随着 mSOFA 评分的每增加 1 分，长时间观察策略组的死亡风险增加（HR 1.29 [95% CI 1.10-1.51]，p = 0.002）。
在新冠病毒 ARF 中，与早期 IMV 相比，长时间观察在 mSOFA 评分较低时与死亡率降低相关，而在 mSOFA 评分较高时与死亡率增加相关。
