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Remdesivir Use in Patients Requiring Mechanical Ventilation due to COVID-19

2020; Oxford University Press; Volume: 7; Issue: 11 Linguagem: Inglês

10.1093/ofid/ofaa481

2328-8957

Giuseppe Lapadula, Davide Paolo Bernasconi, Giacomo Bellani, Alessandro Soria, Roberto Rona, Michela Bombino, Leonello Avalli, Egle Rondelli, Barbara Cortinovis, Enrico Colombo, Maria Grazia Valsecchi, Guglielmo Marco Migliorino, Paolo Bonfanti, Giuseppe Foti, Alessandra Gambaro, Anna Spolti, Ilaria Beretta, Luca Bisi, Anna Cappelletti, Elisabetta Chiesa, Viola Cogliandro, Paola Columpsi, Sergio Foresti, Giulia Gustinetti, Francesca Iannuzzi, Ester Pollastri, Marianna Rossi, Francesca Sabbatini, Nicola Squillace, Daniela Ferlicca, Fabrizia Mauri, Marco Giani, Matteo Pozzi, Vincenzo Russotto, Alessandra Gambaro, Anna Spolti, Ilaria Beretta, Luca Bisi, Anna Cappelletti, Elisabetta Chiesa, Viola Cogliandro, Paola Columpsi, Sergio Foresti, Giulia Gustinetti, Francesca Iannuzzi, Ester Pollastri, Marianna Rossi, Francesca Sabbatini, Nicola Squillace, Daniela Ferlicca, Fabrizia Mauri, Marco Giani, Matteo Pozzi, Vincenzo Russotto,

Respiratory Support and Mechanisms

Remdesivir has been associated with accelerated recovery of severe coronavirus disease 2019 (COVID-19). However, whether it is also beneficial in patients requiring mechanical ventilation is uncertain.All consecutive intensive care unit (ICU) patients requiring mechanical ventilation due to COVID-19 were enrolled. Univariate and multivariable Cox models were used to explore the possible association between in-hospital death or hospital discharge, considered competing-risk events, and baseline or treatment-related factors, including the use of remdesivir. The rate of extubation and the number of ventilator-free days were also calculated and compared between treatment groups.One hundred thirteen patients requiring mechanical ventilation were observed for a median of 31 days of follow-up; 32% died, 69% were extubated, and 66% were discharged alive from the hospital. Among 33 treated with remdesivir (RDV), lower mortality (15.2% vs 38.8%) and higher rates of extubation (88% vs 60%), ventilator-free days (median [interquartile range], 11 [0-16] vs 5 [0-14.5]), and hospital discharge (85% vs 59%) were observed. Using multivariable analysis, RDV was significantly associated with hospital discharge (hazard ratio [HR], 2.25; 95% CI, 1.27-3.97; P = .005) and with a nonsignificantly lower mortality (HR, 0.73; 95% CI, 0.26-2.1; P = .560). RDV was also independently associated with extubation (HR, 2.10; 95% CI, 1.19-3.73; P = .011), which was considered a competing risk to death in the ICU in an additional survival model.In our cohort of mechanically ventilated patients, RDV was not associated with a significant reduction of mortality, but it was consistently associated with shorter duration of mechanical ventilation and higher probability of hospital discharge, independent of other risk factors.