Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe, Japan.
Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe, Japan.
Respir Investig. 2022 Sep;60(5):694-703. doi: 10.1016/j.resinv.2022.06.010. Epub 2022 Jul 11.
Apart from saving the lives of coronavirus disease (COVID-19) patients on mechanical ventilation (MV), recovery from the sequelae of prolonged MV (PMV) is an emerging issue.c METHODS: We conducted a retrospective study among consecutive adult COVID-19 patients admitted to an intensive care unit (ICU) in Kobe, Japan, between March 3, 2020, and January 31, 2021, and received invasive MV. Clinical outcomes included in-hospital mortality and recovery from COVID-19 in survivors regarding organ dysfunction, respiratory symptoms, and functional status at discharge. We compared survivors' outcomes with MV durations of >14 days and ≤14 days.
We included 85 patients with a median age of 69 years (interquartile range, 64-75 years); 76 (89%) patients had at least 1 comorbidity, 72 (85%) were non-frail, and 79 (93%) were functionally independent before COVID-19 infection. Eighteen patients (21%) died during hospitalization. At discharge, 59/67 survivors (88%) no longer required respiratory support, 50 (75%) complained of dyspnea, and 40 (60%) were functionally independent. Of the survivors, 23 patients receiving MV for >14 days had a worse recovery from COVID-19 at discharge compared with those on MV for ≤14 days, as observed using the Barthel index (median: 35 [5-65] vs. 100 [85-100]), ICU mobility scale (8 [5-9] vs. 10 [10-10]), and functional oral intake scale (3 [1-7] vs. 7 [7-7]) (P < 0.0001).
Although four-fifths of the patients survived and >50% of survivors demonstrated clinically important recovery in organ function and functional status during hospitalization, PMV was related to poor recovery from COVID-19 at discharge.
除了挽救接受机械通气（MV）治疗的冠状病毒病（COVID-19）患者的生命外，从长时间 MV（PMV）的后遗症中恢复也是一个新出现的问题。
我们对 2020 年 3 月 3 日至 2021 年 1 月 31 日期间在日本神户的一家重症监护病房（ICU）接受有创 MV 治疗的连续 COVID-19 成年患者进行了回顾性研究。临床结局包括住院死亡率和幸存者出院时器官功能障碍、呼吸症状和功能状态的 COVID-19 恢复情况。我们比较了 MV 时间>14 天和≤14 天的幸存者的结局。
我们纳入了 85 例中位年龄为 69 岁（四分位距，64-75 岁）的患者；76（89%）例患者至少有一种合并症，72（85%）例患者非虚弱，79（93%）例患者在 COVID-19 感染前具有独立的功能。18 例（21%）患者在住院期间死亡。出院时，67 例幸存者中的 59 例（88%）不再需要呼吸支持，50 例（75%）诉呼吸困难，40 例（60%）具有独立的功能。在幸存者中，23 例 MV 时间>14 天的患者与 MV 时间≤14 天的患者相比，出院时 COVID-19 的恢复情况更差，表现在巴氏指数（中位数：35 [5-65] vs. 100 [85-100]）、ICU 移动量表（8 [5-9] vs. 10 [10-10]）和功能性口服摄入量表（3 [1-7] vs. 7 [7-7]）（P<0.0001）。
尽管有五分之四的患者存活下来，并且>50%的幸存者在住院期间的器官功能和功能状态上表现出了具有临床意义的恢复，但 PMV 与出院时 COVID-19 的恢复不良有关。
