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Published on: September 24, 2020
Association between respiratory distress time and invasive mechanical ventilation in COVID-19 patients: A multicentre
S Busani1, I Coloretti1, M Baciarello2
1Anesthesia and Intensive Care Unit, University Hospital of Modena Policlinico, University of Modena and Reggio Emilia, Modena, Italy.
Insights
The duration of respiratory distress symptoms in severe COVID-19 pneumonia significantly increases the need for invasive mechanical ventilation. Early identification and management of respiratory distress are crucial for COVID-19 patients.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Infectious Diseases
Background:
- Severe COVID-19 pneumonia frequently causes respiratory distress.
- The need for mechanical ventilation in these patients is a critical determinant of outcomes.
- Understanding factors influencing ventilation decisions is essential for patient management.
Purpose of the Study:
- To investigate the association between the duration of respiratory distress symptoms and the requirement for invasive mechanical ventilation in severe COVID-19 pneumonia.
- To explore the impact of respiratory distress duration on clinical outcomes.
Main Methods:
- Observational multicentre cohort study involving 171 adult patients with severe COVID-19 pneumonia.
- Patients were stratified into tertiles based on the duration of respiratory distress (DT) before mechanical ventilation.
- Statistical analyses, including univariate and multivariable regression, were used to assess the association between DT and invasive ventilation.
Main Results:
- A significantly higher rate of invasive mechanical ventilation was observed in patients with longer durations of respiratory distress (p < 0.001).
- Respiratory distress time was a significant independent predictor of requiring invasive ventilation (OR 10.7, p < 0.001).
- No significant differences in clinical outcomes, such as mortality and hospital stay, were found between different DT tertiles.
Conclusions:
- The duration of respiratory distress symptoms may be a key factor influencing the need for invasive mechanical ventilation in severe COVID-19.
- These findings suggest the importance of early identification and management strategies for respiratory distress in COVID-19 patients.
- Further research is warranted to validate these preliminary retrospective findings and refine clinical protocols.
Aim:
To determine whether the duration of respiratory distress symptoms in severe COVID-19 pneumonia affects the need for invasive mechanical ventilation and clinical outcomes.
Materials And Methods:
An observational multicentre cohort study of patients hospitalised in five COVID-19-designated ICUs of the University Hospitals of Emilia-Romagna Region. Patients included were adults with pneumonia due to SARS-CoV-2 with PaO₂/FiO₂ ratio <300 mmHg, respiratory distress symptoms, and need for mechanical ventilation (invasive or non-invasive). Exclusion criteria were an uncertain time of respiratory distress, end-of-life decision, and mechanical respiratory support before hospital admission.
Measurements And Main Results:
We analysed 171 patients stratified into tertiles according to respiratory distress duration (distress time, DT) before application of mechanical ventilation support. The rate of patients requiring invasive mechanical ventilation was significantly different (p < 0.001) among the tertiles: 17/57 patients in the shortest duration, 29/57 in the intermediate duration, and 40/57 in the longest duration. The respiratory distress time significantly increased the risk of invasive ventilation in the univariate analysis (OR 5.5 [CI 2.48-12.35], p = 0.003). Multivariable regression analysis confirmed this association (OR 10.7 [CI 2.89-39.41], p < 0.001). Clinical outcomes (mortality and hospital stay) did not show significant differences between DT tertiles.
Discussion:
Albeit preliminary and retrospective, our data raised the hypothesis that the duration of respiratory distress symptoms may play a role in COVID-19 patients' need for invasive mechanical ventilation. Furthermore, our observations suggested that specific strategies may be directed towards identifying and managing early symptoms of respiratory distress, regardless of the levels of hypoxemia and the severity of the dyspnoea itself.
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