Respiratory Care Division, Department of Anesthesia and Perioperative Care, University of California, San Francisco at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
Department of Anesthesia and Perioperative Care, University of California, San Francisco at San Francisco General Hospital, San Francisco, California.
Respir Care. 2023 Oct;68(10):1340-1346. doi: 10.4187/respcare.09876. Epub 2023 Jun 6.
Pneumonia from COVID-19 that results in ARDS may require invasive mechanical ventilation. This retrospective study assessed the characteristics and outcomes of subjects with COVID-19-associated ARDS versus ARDS (non-COVID) during the first 6 months of the COVID-19 pandemic in 2020. The primary objective was to determine whether mechanical ventilation duration differed between these cohorts and identify other potential contributory factors.
We retrospectively identified 73 subjects admitted between March 1 and August 12, 2020, with either COVID-19-associated ARDS (37) or ARDS (36) who were managed with the lung protective ventilator protocol and required >48 h of mechanical ventilation. Exclusion criteria were the following: <18 years old or the patient required tracheostomy or interfacility transfer. Demographic and baseline clinical data were collected at ARDS onset (ARDS day 0), with subsequent data collected on ARDS days 1-3, 5, 7, 10, 14, and 21. Comparisons were made by using the Wilcoxon rank-sum test (continuous variables) and chi-square test (categorical variables) stratified by COVID-19 status. A Cox proportional hazards model assessed the cause-specific hazard ratio for extubation.
The median (interquartile range) mechanical ventilation duration among the subjects who survived to extubation was longer in those with COVID-19-ARDS versus the subjects with non-COVID ARDS: 10 (6-20) d versus 4 (2-8) d; < .001. Hospital mortality was not different between the two groups (22% vs 39%; = .11). The competing risks Cox proportional hazard analysis (fit among the total sample, including non-survivors) revealed that improved compliance of the respiratory system and oxygenation were associated with the probability of extubation. Oxygenation improved at a lower rate in the subjects with COVID-19-associated ARDS than in the subjects with non-COVID ARDS.
Mechanical ventilation duration was longer in subjects with COVID-19-associated ARDS compared with the subjects with non-COVID ARDS, which may be explained by a lower rate of improvement in oxygenation status.
由 COVID-19 引起的肺炎导致急性呼吸窘迫综合征可能需要进行有创机械通气。本回顾性研究评估了 2020 年 COVID-19 大流行的前 6 个月期间，COVID-19 相关急性呼吸窘迫综合征（ARDS）患者与非 COVID-19 ARDS 患者的特征和结局。主要目的是确定这两组患者的机械通气时间是否存在差异，并确定其他潜在的促成因素。
我们回顾性地确定了 2020 年 3 月 1 日至 8 月 12 日期间收治的 73 名患者，这些患者均患有 COVID-19 相关 ARDS（37 名）或非 COVID-19 ARDS（36 名），均采用肺保护性通气方案治疗，需要>48 小时的机械通气。排除标准为：年龄<18 岁或患者需要行气管切开术或院内转科。在 ARDS 发病时（ARDS 第 0 天）收集人口统计学和基线临床数据，随后在 ARDS 第 1-3、5、7、10、14 和 21 天收集数据。采用 Wilcoxon 秩和检验（连续变量）和卡方检验（分类变量）对 COVID-19 状态进行分层比较。Cox 比例风险模型评估了拔管的特定原因风险比。
存活至拔管的患者中，COVID-19-ARDS 患者的中位（四分位距）机械通气时间长于非 COVID-19 ARDS 患者：10（6-20）d 与 4（2-8）d；<0.001。两组间的住院死亡率无差异（22% vs 39%；=0.11）。总样本（包括非幸存者）的竞争风险 Cox 比例风险分析显示，呼吸系统顺应性和氧合改善与拔管的概率相关。COVID-19 相关 ARDS 患者的氧合改善速度低于非 COVID-19 ARDS 患者。
与非 COVID-19 ARDS 患者相比，COVID-19 相关 ARDS 患者的机械通气时间更长，这可能是由于氧合状态改善的速度较慢所致。
