Clinical Features of Coronavirus Disease 2019 Patients With Mechanical Ventilation: A Nationwide Study in China*

Abstract

Objectives: The outbreak of coronavirus disease 2019 is becoming a worldwide pandemic. Mechanical ventilation is lifesaving for respiratory distress, this study was designed to delineate the clinical features of the coronavirus disease 2019 patients with mechanical ventilation from a national cohort in China. Design: Prospective observational study. Setting: The rapid spread of severe acute respiratory syndrome coronavirus 2 has infected more than 7.7 million people and caused more than 423,000 deaths. Patients: Adult hospitalized coronavirus disease 2019 patients with mechanical ventilation from 557 hospitals from China. Interventions: None. Measurements and Main Results: From a nationwide cohort, 141 coronavirus disease 2019 cases with mechanical ventilation were extracted from 1,590 cases. Cigarette smoke, advanced age, coexisting chronic illness, elevated systolic blood pressure, high body temperature, and abnormal laboratory findings are common in these ventilated cases. Multivariate regression analysis showed that higher odds of in-hospital death was associated with invasive mechanical ventilation requirement (hazard ratio: 2.95; 95% CI, 1.40-6.23; p = 0.005), and coexisting chronic obstructive pulmonary disease (hazard ratio, 4.57; 95% CI, 1.65-12.69; p = 0.004) and chronic renal disease (hazard ratio, 5.45; 95% CI, 1.85-16.12; p = 0.002). Compared with patients with noninvasive mechanical ventilation, patients who needs invasive mechanical ventilation showed higher rate of elevated d-dimer (> 1.5 mg/L) at admission (hazard ratio, 3.28, 95% CI, 1.07-10.10; p = 0.039). Conclusions:The potential risk factors of elevated d-dimer level could help clinicians to identify invasive mechanical ventilation requirement at an early stage, and coexisting chronic obstructive pulmonary disease or chronic renal disease are independent risk factors associated with fatal outcome in coronavirus disease 2019 patients with mechanical ventilation. (Crit Care Med 2020; XX:00-00

Role of Biochemical Markers in Invasive Ventilation of Coronavirus Disease 2019 Patients: Multinomial Regression and Survival Analysis

“…This finding is similar to the results from a nationwide study conducted in China, where they reported elevated D-dimer on admission suggested a greater likelihood of invasive mechanical ventilation. The percentage of patients in the invasive and non-invasively ventilation groups with elevated D-dimer levels on admission were slightly different from our study, with a higher percentage of our subjects having elevated D-dimer levels (75.7% vs 66.7% in the invasive group and 69.1% vs 44.6% in the non-invasive group respectively) [11].…”

“…LDH was also found to be significantly elevated on admission in patients that required invasive ventilation and was the second most effective predictor of mortality after D-dimer. Studies conducted in China and Korea support our results of LDH as an effective predictor of the need for invasive ventilation in COVID-19 patients [11,12]. When looking at the elevated levels of LDH on admission in the invasive and non-invasive groups, the percentage of patients in our study was 81.4% and 69.6% respectively.…”

Changes in serum virus-specific IgM/IgG antibody in asymptomatic and discharged patients with reoccurring positive COVID-19 nucleic acid test (RPNAT)

“…Many studies [8,9,12,13] have investigated the clinical, laboratory and radiological features of confirmed symptomatic COVID-19 patients. However, there is little attention given to the follow-up of recovered patients.…”

Non-invasive ventilation in patients with novel coronavirus infection COVID-19

“…При этом большинство случаев инфицирования медицинских работников произошло на ранней стадии вспышки COVID-19, поскольку в то время еще отсутствовала информация о высокой контагиозности коронавирусной инфекции и, следовательно, индивидуальная защита являлась недостаточной. При использовании СИЗ инфицирования медицинских работников можно избежать даже при работе с пациентами с НВЛ, о чем свидетельствовали лишь единичные случаи заражения медицинских работников в более поздний период пандемии [37]. Таким образом, при работе с НВЛ риск контаминации вирусными инфекциями сводится к минимуму при адекватном использовании СИЗ.…”

“…К сожалению, сегодня нет надежных маркеров прогрессирования заболевания на фоне проведения НВЛ. В исследовании W.Wang et al, описывающем общенациональную когорту критически больных COVID-19 в Китае, повышенный уровень D-димера (> 1,5 мг / л) при поступлении был индикатором высокой вероятности подключения к ИВЛ [37]. Эти результаты согласуются с данными о том, что повышение уровня D-димера у пациентов с COVID-19 связано с прогрессированием заболевания [68].…”