Ventilator avoidance among critically ill COVID-19 patients with acute respiratory distress syndrome

• Published in: Journal of international medical research Vol. 50; no. 11; p. 3000605221135446
• Main Authors: Fletcher, Jeffrey J, Aughenbaugh, Arielle, Svabek, Catherine, Hahn, Peter Y, Grifka, Ronald G
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.11.2022; Sage Publications Ltd; SAGE Publishing
• Subjects: Coronaviruses; COVID-19; Intubation; Mortality; Patient compliance; Prospective Clinical Research Report; Respiratory distress syndrome; Severe acute respiratory syndrome coronavirus 2; Ventilators; COVID-19; intubation refusal; medical noncompliance; treatment refusal; medication adherence; misinformation
• ISSN: 0300-0605; 1473-2300
• DOI: 10.1177/03000605221135446

Objective To determine the incidence and significance of ventilator avoidance in patients with critical coronavirus disease 2019 (COVID-19). Methods This prospective observational cohort study evaluated hospital mortality and 1-year functional outcome among critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated acute respiratory distress syndrome (ARDS). The explanatory variable was ventilator avoidance, modeled as ‘initial refusal’ of intubation (yes/no). Modified Rankin Scale (mRS) scores were obtained from surviving patients (or their surrogates) via phone or email questionnaire. Results Among patients for whom intubation was recommended (n = 102), 40 (39%) initially refused (95% confidence interval [CI] 30%, 49%). The risk of death was 79.3% (49/62) in those who did not initially refuse intubation compared with 77.5% (31/40) in those who initially refused, with an adjusted odds ratio for death of 1.27 (95% CI 0.47, 3.48). The distribution of 1-year mRS scores was not significantly different between groups. Conclusion Among critically ill patients with COVID-19-associated ARDS, ventilator avoidance was common, but was not associated with increased in-hospital mortality or 1-year functional outcome.