Factors associated with withholding of invasive mechanical ventilation in the early phase of the COVID-19 response and their ethical analyses

Abstract

Background End-of-life decision making regarding invasive mechanical ventilation (IMV) for patients with severe coronavirus disease (COVID-19) is challenging. We aimed to explore the factors associated with the withholding of IMV in patients with COVID-19. Methods This retrospective study included patients registered in a nationwide COVID-19 Registry Japan. We enrolled patients with COVID-19 admitted between January 1, 2020, and June 30, 2021, and died during hospitalisation. The enrolled patients were divided into two groups: those who received IMV (IMV group) and those who did not (non-IMV group). To identify the factors associated with withholding of IMV among patients with COVID-19 who died during hospitalisation, we conducted a multivariate logistic regression analysis. Results A total of 2401 patients were enrolled. Of these, 588 (24.5%) were in the IMV group and 1813 (75.5%) in the non-IMV group. Withholding IMV was positively associated with older age (95% confidence interval [CI]: 0.82–0.88, p < 0.0001), dementia (95% CI: 0.81–0.91, p < 0.0001), chronic lung disease (95% CI: 0.88–1.00, p = 0.036), and malignancy (95% CI: 0.82–0.94, p < 0.0004) although inversely associated with male sex (95% CI: 1.04–1.15, p = 0.0008), body mass index (95% CI: 1.01–1.02, p < 0.0001), and National Early Warning Score (95% CI: 1.01–1.03, p < 0.0001). Conclusions We explored factors associated with the withholding of IMV and analysed the results to prepare for future emerging infectious disease pandemics by taking a retrospective look at the decision-making process during the COVID-19 disaster and considering multidisciplinary collaboration.