tetano
Editor, Senior Moderator
Crit Care Sci
. 2023 Mar 1;35(1):19-30.
doi: 10.5935/2965-2774.20230203-en. Factors associated with mortality in mechanically ventilated patients with severe acute respiratory syndrome due to COVID-19 evolution
João Paulo Arruda de Oliveira[SUP] 1 [/SUP], Andreia Cristina Travassos Costa[SUP] 2 [/SUP], Agnaldo José Lopes[SUP] 1 [/SUP], Arthur de Sá Ferreira[SUP] 1 [/SUP], Luis Felipe da Fonseca Reis[SUP] 1 [/SUP]
Affiliations
Objectives: To evaluate the factors associated with mortality in mechanically ventilated patients with acute respiratory distress syndrome due to COVID-19.
Methods: This was a retrospective, multicenter cohort study that included 425 mechanically ventilated adult patients with COVID-19 admitted to 4 intensive care units. Clinical data comprising the SOFA score, laboratory data and mechanical characteristics of the respiratory system were collected in a standardized way immediately after the start of invasive mechanical ventilation. The risk factors for death were analyzed using Cox regression to estimate the risk ratios and their respective 95%CIs.
Results: Body mass index (RR 1.17; 95%CI 1.11 - 1.20; p < 0.001), SOFA score (RR 1.39; 95%CI 1.31 - 1.49; p < 0.001) and driving pressure (RR 1.24; 95%CI 1.21 - 1.29; p < 0.001) were considered independent factors associated with mortality in mechanically ventilated patients with acute respiratory distress syndrome due to COVID-19. Respiratory system compliance (RR 0.92; 95%CI 0.90 - 0.93; p < 0.001) was associated with lower mortality. The comparative analysis of the survival curves indicated that patients with respiratory system compliance (< 30mL/cmH2O), a higher SOFA score (> 5 points) and higher driving pressure (> 14cmH2O) were more significantly associated with the outcome of death at 28 days and 60 days.
Conclusion: Patients with a body mass index > 32kg/m2, respiratory system compliance < 30mL/cmH2O, driving pressure > 14cmH2O and SOFA score > 5.8 immediately after the initiation of invasive ventilatory support had worse outcomes, and independent risk factors were associated with higher mortality in this population.
Keywords: COVID-19; Coronavirus infections; Mortality; Respiration; Respiratory distress syndrome; Respiratory mechanics; SARS-CoV-2; artificial.
. 2023 Mar 1;35(1):19-30.
doi: 10.5935/2965-2774.20230203-en. Factors associated with mortality in mechanically ventilated patients with severe acute respiratory syndrome due to COVID-19 evolution
João Paulo Arruda de Oliveira[SUP] 1 [/SUP], Andreia Cristina Travassos Costa[SUP] 2 [/SUP], Agnaldo José Lopes[SUP] 1 [/SUP], Arthur de Sá Ferreira[SUP] 1 [/SUP], Luis Felipe da Fonseca Reis[SUP] 1 [/SUP]
Affiliations
- PMID: 37712726
- DOI: 10.5935/2965-2774.20230203-en
Objectives: To evaluate the factors associated with mortality in mechanically ventilated patients with acute respiratory distress syndrome due to COVID-19.
Methods: This was a retrospective, multicenter cohort study that included 425 mechanically ventilated adult patients with COVID-19 admitted to 4 intensive care units. Clinical data comprising the SOFA score, laboratory data and mechanical characteristics of the respiratory system were collected in a standardized way immediately after the start of invasive mechanical ventilation. The risk factors for death were analyzed using Cox regression to estimate the risk ratios and their respective 95%CIs.
Results: Body mass index (RR 1.17; 95%CI 1.11 - 1.20; p < 0.001), SOFA score (RR 1.39; 95%CI 1.31 - 1.49; p < 0.001) and driving pressure (RR 1.24; 95%CI 1.21 - 1.29; p < 0.001) were considered independent factors associated with mortality in mechanically ventilated patients with acute respiratory distress syndrome due to COVID-19. Respiratory system compliance (RR 0.92; 95%CI 0.90 - 0.93; p < 0.001) was associated with lower mortality. The comparative analysis of the survival curves indicated that patients with respiratory system compliance (< 30mL/cmH2O), a higher SOFA score (> 5 points) and higher driving pressure (> 14cmH2O) were more significantly associated with the outcome of death at 28 days and 60 days.
Conclusion: Patients with a body mass index > 32kg/m2, respiratory system compliance < 30mL/cmH2O, driving pressure > 14cmH2O and SOFA score > 5.8 immediately after the initiation of invasive ventilatory support had worse outcomes, and independent risk factors were associated with higher mortality in this population.
Keywords: COVID-19; Coronavirus infections; Mortality; Respiration; Respiratory distress syndrome; Respiratory mechanics; SARS-CoV-2; artificial.