Long-term survival of mechanically ventilated patients with severe COVID-19: an observational cohort study

Abstract

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)

Ventilator-associated pneumonia in critically-ill patients with COVID-19 in a setting of selective decontamination of the digestive tract

“…Demographics, treatments and outcomes between patients described in this report and previous literature are similar, however major differences are the use of SDD and the incidence of VAP [ 1 – 3 ]. In support of our data, a recently published observational study, suggests a strong mortality benefit of SDD, although the incidence of VAP was not reported [ 6 ].…”

Characteristics of mechanically ventilated COVID-19 patients in the Al-Ahsa Region of Saudi Arabia: a retrospective study with survival analysis

“… 31 On the other hand, a Spanish study reported a better survival probability in mechanically ventilated COVID-19 patients (>50% after 180 days of follow up). 32 The meta-analysis of 69 studies by Lim et al reported a CFR of 45% (95% CI: 39 to 52%) among mechanically ventilated COVID-19. 33 The difference in CFRs reported in the literature might be related to quality of care, setting and/or regional differences.…”

Mechanical Ventilation in COVID-19 Patients: Insights into the Role of Age and Frailty from a Multicentre Observational Study

“…This is line with previous reports that the severity of respiratory failure at admission is associated with disease progression and COVID-19-associated mortality [ 15 ]. Similarly, in a study of 868 patients receiving MV in the ICU for COVID-19, a failed attempt at non-invasive positive pressure ventilation prior to orotracheal intubation was associated with an almost 2-fold increase in 6-month mortality (odds ratio 1.878 (95% CI 1.124-3.140)) [ 16 ].…”