P101 Mortality in patients requiring home mechanical ventilation during the COVID-19 pandemic: experiences of a regional specialist ventilation unit

• Published in: Thorax Vol. 76; no. Suppl 2; pp. A121 - A122
• Main Authors: D’Cruz, RF, Shah, NM, Learoyd, A, Elias, OJ, Mackie, M, Weston, N, Kaltsakas, G, Suh, ES, Marino, P, Ramsay, M, Srivastava, S, Pattani, H, Steier, J, Hart, N, Murphy, PB
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 08.11.2021; BMJ Publishing Group LTD
• Subjects: Coronaviruses; COVID-19; Disease; Mortality; Neuromuscular diseases; Obesity; Pandemics; Respiratory failure; Severe acute respiratory syndrome coronavirus 2; The wider impact of the pandemic; Ventilation; United Kingdom > UK
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax-2021-BTSabstracts.210

IntroductionDeaths from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection continue to increase in the UK. Patients with pre-existing comorbidities, including obesity and chronic respiratory disease, have been shown to be at increased risk of adverse clinical outcomes. The impact of COVID-19 on the survival of patients established on home mechanical ventilation (HMV) for chronic respiratory failure is currently unknown. We aimed to evaluate longitudinal trends in mortality amongst patients requiring HMV at a UK tertiary specialist ventilation unit.Methods20-year single-centre retrospective observational cohort study. Medical records of HMV users were used to determine mortality status and date of death. Primary cause of chronic hypercapnic respiratory failure was coded as chest wall disease, diseases of the lungs/airways, rapidly- or slowly-progressive neuromuscular disease and obesity-related respiratory failure.Results4766 consecutive records between 1st January 2000 and 31st August 2020 were reviewed. Evaluation of deaths occurring during and subsequent to the UK second wave are ongoing. Mortality rates in March 2020 (1.68%) and April 2020 (1.64%) were higher than 2000–2019 (mean±SD 0.70±0.34% and 0.68±0.39% in March and April, respectively) (figure 1A), followed by a fall in May to 0.66%, comparable to pre-COVID levels. A larger proportion of HMV users with obesity-related respiratory failure died between March-April 2020 (41.0%) compared to the same period in 2019 (11.4%) and all previous years (figure 1B). The proportion of HMV users with lung/airways disease, slowly-progressive neuromuscular disease and chest wall disease who died in this period were reduced compared to previous years.Abstract P101 Figure 1(A) Monthly mortality of patients under Lane Fox Respiratory Service follow-up, dotted lines represent upper and lower bounds of 95% confidence intervals (B) Proportion of home mechanical ventilation (HMV) users in each disease category who died between 1st March and 30th ApriI by yearConclusionsDeaths amongst HMV users at our regional ventilation centre were highest in the first two months following the onset of the COVID-19 pandemic. A subsequent fall in mortality may relate to effective shielding advice following national lockdown and departmental guidance offered. The majority of deaths were in patients with obesity-related respiratory failure. These data support previous observations that obesity is a major risk factor for adverse outcomes in patients with COVID-19.