Prognostic factors and outcomes in COVID-19 patients requiring prolonged mechanical ventilation: a retrospective cohort study

• Published in: Therapeutic advances in respiratory disease Vol. 16; p. 17534666221086415
• Main Authors: Melamed, Roman, Paz, Francisco, Jepsen, Stacy, Smith, Claire, Saavedra, Ramiro, Mulder, Maximilian, Masood, Adnan, Huelster, Joshua, Kirkland, Lisa, Guenther, Alena, Boland, Lori
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.03.2022; SAGE PUBLICATIONS, INC; SAGE Publishing
• Subjects: Cohort analysis; Cohort Studies; Coronaviruses; COVID-19; COVID-19 - therapy; Humans; Medical prognosis; Mortality; Original Research; Ostomy; Prognosis; Respiration, Artificial; Respiratory failure; Retrospective Studies; Ventilators; length of stay; respiratory failure; COVID-19 virus disease; mechanical ventilation; intensive care units
• ISSN: 1753-4666; 1753-4658; 1753-4666
• DOI: 10.1177/17534666221086415

Background: Mechanical ventilation (MV) in coronavirus disease 2019 (COVID-19) patients is associated with high mortality and extensive resource utilization. The aim of this study was to investigate prognostic factors and outcomes associated with prolonged mechanical ventilation (PMV) in COVID-19 patients. Methods: This was a retrospective cohort study of COVID-19 patients requiring invasive MV who were hospitalized between 1 March 2020 and 30 June 2021 in the intensive care units (ICUs) of three referral hospitals belonging to a single health system. Data were extracted from electronic health records. PMV was defined as  > 17 days of MV. Results: Of 355 patients studied, 86 (24%) required PMV. PMV patients had lower PaO2/FiO2 ratio, higher PCO2, and higher plateau and driving pressures during the first 2 weeks of MV than their short MV (SMV; ⩽ 17 days) counterparts. PMV patients received more proning, neuromuscular blockade, and tracheostomy, had longer ICU and hospital length of stay (LOS), and required discharge to an inpatient rehabilitation facility more frequently (all p < 0.001). Overall 30-day mortality was 43.9%, with no statistically significant difference between PMV and SMV groups. In PMV patients, smoking, Charlson comorbidity index > 6, and week 2 PaO2/FiO2 ratio < 150 and plateau pressure ⩾ 30 were positively associated with 30-day mortality. In a multivariate model, results were directionally consistent with the univariate analysis but did not reach statistical significance. Conclusion: PMV is commonly required in COVID-19 patients with respiratory failure. Despite the higher need for critical care interventions and LOS, more than half of the PMV cohort survived to hospital discharge. Higher PaO2/FiO2 ratio, lower plateau pressure, and fewer comorbidities appear to be associated with survival in this group.