Time to Extubation Among ARDS Subjects With and Without COVID-19 Pneumonia.
BACKGROUND: 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...
| Publicado en: | Respiratory Care Vol. 68; no. 10; pp. 1340 - 1347 |
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| Autores principales: | , , , , , |
| Formato: | CEU research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Oct2023
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=172028556&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 172028556 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Oct2023 vid: 68 iid: 10 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 172028556 172028556 172028556 10.4187/respcare.09876 172028556 ppf: 1340 ppct: 7 formats: fmt: @attributes: type: P tig: atl: Time to Extubation Among ARDS Subjects With and Without COVID-19 Pneumonia. aug: au: Burns, Gregory D. Phillips, Justin S. Kallet, Richard H. Glidden, David V. Hendrickson, Carolyn M. Metcalfe, John Z. affil: 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 sug: subj: Respiratory Distress Syndrome, Acute Therapy Extubation Pneumonia, Viral COVID-19 Respiration, Artificial Treatment Duration Human Education, Continuing (Credit) Retrospective Design Descriptive Statistics Wilcoxon Rank Sum Test Chi Square Test Cox Proportional Hazards Model Hospital Mortality Risk Factors Oxygenation Recovery Adult Middle Age Aged Male Female APACHE (Acute Physiology and Chronic Health Evaluation) Questionnaires Positive End-Expiratory Pressure Forced Expiratory Volume Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Male Female ab: BACKGROUND: 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. METHODS: 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. RESULTS: 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; P < .001. Hospital mortality was not different between the two groups (22% vs 39%; P 5 .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. CONCLUSIONS: 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. pubtype: Academic Journal doctype: CEU research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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