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Outcomes of mechanically ventilated patients with COVID-19 associated respiratory failure
Christopher S King1, Dhwani Sahjwani2, A Whitney Brown1
1Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, United States of America.
Insights
Outcomes for COVID-19 patients on invasive mechanical ventilation are poor, especially for older individuals. However, younger patients requiring mechanical ventilation have a reasonable chance of recovery.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pulmonology
Background:
- Outcomes for patients with COVID-19 requiring invasive mechanical ventilation are not well-defined.
- Understanding clinical characteristics and outcomes is crucial for managing this patient population.
Purpose of the Study:
- To determine the clinical characteristics and outcomes of patients with COVID-19 managed with invasive mechanical ventilation.
- To assess mortality rates and factors associated with survival in this cohort.
Main Methods:
- Retrospective electronic medical record review of COVID-19 patients.
- Inclusion criteria: patients admitted to Inova Health System between March 5, 2020, and April 26, 2020, requiring invasive mechanical ventilation.
- Data collected included demographics, clinical markers, and patient disposition.
Main Results:
- 164 out of 1023 COVID-19 patients (16.0%) required invasive mechanical ventilation.
- Overall mortality was 42.7% (70/164), with 57.3% (94/164) surviving.
- Deceased patients were older (median 66 vs. 55 years) with higher d-dimer and ferritin levels.
- Patients over 70 had an 84.3% mortality rate, while those 70 or younger had a 67.4% survival rate.
- Younger age, non-Caucasian race, and tertiary care center treatment were associated with survival.
Conclusions:
- Mortality for COVID-19 patients on invasive mechanical ventilation is high, particularly in older individuals.
- A significant proportion of ventilated patients were not elderly and had a reasonable chance of recovery.
- Age is a critical factor influencing survival outcomes in mechanically ventilated COVID-19 patients.
Purpose:
The outcomes of patients requiring invasive mechanical ventilation for COVID-19 remain poorly defined. We sought to determine clinical characteristics and outcomes of patients with COVID-19 managed with invasive mechanical ventilation in an appropriately resourced US health care system.
Methods:
Outcomes of COVID-19 infected patients requiring mechanical ventilation treated within the Inova Health System between March 5, 2020 and April 26, 2020 were evaluated through an electronic medical record review.
Results:
1023 COVID-19 positive patients were admitted to the Inova Health System during the study period. Of these, 164 (16.0%) were managed with invasive mechanical ventilation. All patients were followed to definitive disposition. 70/164 patients (42.7%) had died and 94/164 (57.3%) were still alive. Deceased patients were older (median age of 66 vs. 55, p <0.0001) and had a higher initial d-dimer (2.22 vs. 1.31, p = 0.005) and peak ferritin levels (2998 vs. 2077, p = 0.016) compared to survivors. 84.3% of patients over 70 years old died in the hospital. Conversely, 67.4% of patients age 70 or younger survived to hospital discharge. Younger age, non-Caucasian race and treatment at a tertiary care center were all associated with survivor status.
Conclusion:
Mortality of patients with COVID-19 requiring invasive mechanical ventilation is high, with particularly daunting mortality seen in patients of advanced age, even in a well-resourced health care system. A substantial proportion of patients requiring invasive mechanical ventilation were not of advanced age, and this group had a reasonable chance for recovery.
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