Long-term survival of mechanically ventilated patients with severe COVID-19 : an observational cohort study
Peñuelas, Oscar (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias)
del Campo-Albendea, Laura (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública)
Lesmes González de Aledo, Amanda (Hospital Universitario 12 de Octubre (Madrid))
Añón, José Manuel (Instituto de Investigación Sanitaria del Hospital Universitario La Paz)
Rodríguez-Solís, Carmen (Hospital Universitario de Getafe (Madrid))
Mancebo, Jordi (Institut d'Investigació Biomèdica Sant Pau)
Vera-Artazcoz, Paula (Institut d'Investigació Biomèdica Sant Pau)
Ballesteros Orozco, Daniel (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Jiménez, Jorge (Hospital Universitario de Getafe (Madrid))
Maseda, Emilio (Hospital Universitario La Paz (Madrid))
Figueira, Juan Carlos (Instituto de Investigación Sanitaria del Hospital Universitario La Paz)
Franco, Nieves (Hospital Universitario de Móstoles (Madrid))
Algaba, Ángela (Hospital Universitario de Torrejón)
Avilés, Juan Pablo (Hospital Universitario Severo Ochoa)
Díaz, Ricardo (Hospital Universitario Severo Ochoa)
Abad, Beatriz (Hospital Universitario de la Princesa (Madrid))
Canabal, Alfonso (Hospital Universitario de la Princesa (Madrid))
Abella, Ana (Hospital Universitario del Henares ( Madrid))
Gordo Vidal, Federico (Hospital Universitario del Henares ( Madrid))
García, Javier (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
García Suarez, Jessica (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Cedeño, Jamil (Hospital General Universitario Gregorio Marañón)
Martínez-Palacios, Basilia (Hospital Universitario Infanta Cristina)
Manteiga, Eva (Hospital Universitario Infanta Cristina)
Martínez, Óscar (Hospital Universitario del Tajo)
Blancas, Rafael (Hospital Universitario del Tajo)
Bardi, Tommaso (Hospital Universitario Ramón y Cajal (Madrid))
Pestaña, David (Hospital Universitario Ramón y Cajal (Madrid))
Lorente, Jose Ángel (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias)
Muriel, Alfonso (Hospital Ramón Y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria & Centro de Investigación Biomédica en Red de Epidemiología Y Salud Pública)
Esteban, Andrés (Hospital Universitario de Getafe (Madrid))
Frutos-Vivar, Fernando (Hospital Universitario de Getafe (Madrid))

Data:	2021
Resum:	Background: Information is lacking regarding long-term survival and predictive factors for mortality in patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) and undergoing invasive mechanical ventilation. We aimed to estimate 180-day mortality of patients with COVID-19 requiring invasive ventilation, and to develop a predictive model for long-term mortality. Methods: Retrospective, multicentre, national cohort study between March 8 and April 30, 2020 in 16 intensive care units (ICU) in Spain. Participants were consecutive adults who received invasive mechanical ventilation for COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection detected in positive testing of a nasopharyngeal sample and confirmed by real time reverse-transcriptase polymerase chain reaction (rt-PCR). The primary outcomes was 180-day survival after hospital admission. Secondary outcomes were length of ICU and hospital stay, and ICU and in-hospital mortality. A predictive model was developed to estimate the probability of 180-day mortality. Results: 868 patients were included (median age, 64 years [interquartile range [IQR], 56-71 years]; 72% male). Severity at ICU admission, estimated by SAPS3, was 56 points [IQR 50-63]. Prior to intubation, 26% received some type of noninvasive respiratory support. The unadjusted overall 180-day survival rates was 59% (95% CI 56-62%). The predictive factors measured during ICU stay, and associated with 180-day mortality were: age [Odds Ratio [OR] per 1-year increase 1. 051, 95% CI 1. 033-1. 068)), SAPS3 (OR per 1-point increase 1. 027, 95% CI 1. 011-1. 044), diabetes (OR 1. 546, 95% CI 1. 085-2. 204), neutrophils to lymphocytes ratio (OR per 1-unit increase 1. 008, 95% CI 1. 001-1. 016), failed attempt of noninvasive positive pressure ventilation prior to orotracheal intubation (OR 1. 878 (95% CI 1. 124-3. 140), use of selective digestive decontamination strategy during ICU stay (OR 0. 590 (95% CI 0. 358-0. 972) and administration of low dosage of corticosteroids (methylprednisolone 1 mg/kg) (OR 2. 042 (95% CI 1. 205-3. 460). Conclusion: The long-term survival of mechanically ventilated patients with severe COVID-19 reaches more than 50% and may help to provide individualized risk stratification and potential treatments. Trial registration: ClinicalTrials. gov Identifier: NCT04379258. Registered 10 April 2020 (retrospectively registered).
Ajuts:	Instituto de Salud Carlos III COV20/00977
Nota:	Altres ajuts: Fundación para la Investigación Biomédica del Hospital Universitario de Getafe (0010604).
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Coronavirus disease 2019 ; COVID-19 ; ARDS ; Intensive care unit ; Invasive mechanical ventilation ; Mortality ; Pneumonia ; SARS-CoV-2 ; Noninvasive ventilation
Publicat a:	Annals of Intensive Care, Vol. 11 Núm. 1 (december 2021) , p. 143, ISSN 2110-5820

DOI: 10.1186/s13613-021-00929-y
PMID: 34601646

11 p, 933.7 KB

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