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Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs

2020; BioMed Central; Volume: 8; Issue: 1 Linguagem: Inglês

10.1186/s40560-020-00499-4

2052-0492

Lorenzo Gamberini, Tommaso Tonetti, Savino Spadaro, Gianluca Zani, Carlo Alberto Mazzoli, Chiara Capozzi, Emanuela Giampalma, Maria Letizia Bacchi Reggiani, Elisabetta Bertellini, Andrea Castelli, Irene Cavalli, Davide Colombo, Federico Crimaldi, Federica Damiani, Alberto Fogagnolo, Maurizio Fusari, Emiliano Gamberini, Giovanni Gordini, Cristiana Laici, Maria Concetta Lanza, Mirco Leo, Andrea Marudi, Giuseppe Nardi, Irene Ottaviani, Raffaella Papa, Antonella Potalivo, Emanuele Russo, Stefania Taddei, Carlo Alberto Volta, V. Marco Ranieri, Marco Tartaglione, Valentina Chiarini, Virginia Buldini, Carlo Coniglio, Federico Moro, Nicola Cilloni, L Giuntoli, Angela Bellocchio, Emanuele Matteo, Giacinto Pizzilli, Antonio Daniele Pinna, Chiara Tartivita, Francesco Maria Di Matteo, Annalisa Marchio, Igor Bacchilega, Laura Bernabé, Sonia Guarino, Elena Mosconi, Luca Bissoni, Lorenzo Viola, Tommaso Meconi, Vittorio Pavoni, Aline Pagni, Patrizia Pompa Cleta, Marco Cavagnino, Anna Malfatto, Angelina Adduci, Silvia Pareschi, Gabriele Melegari, Jessica Maccieri, Elisa Marinangeli, Fabrizio Racca, Marco Verri, Giulia Falò, Elisabetta Marangoni, Francesco Bonì, Giulia Felloni, Federico Domenico Baccarini, Marina Terzitta, Stefano Maitan, Michele Imbriani, Paolo Emilio Orlandi, Giorgia Dalpiaz, Rita Golfieri, Federica Ciccarese, Antonio Poerio, Francesco Muratore, Fabio Ferrari, Martina Mughetti, Loredana Franchini, Ersenad Neziri, Marco Miceli, Maria Teresa Minguzzi, Lorenzo Mellini, Sara Piciucchi,

Long-Term Effects of COVID-19

A large proportion of patients with coronavirus disease 2019 (COVID-19) develop severe respiratory failure requiring admission to the intensive care unit (ICU) and about 80% of them need mechanical ventilation (MV). These patients show great complexity due to multiple organ involvement and a dynamic evolution over time; moreover, few information is available about the risk factors that may contribute to increase the time course of mechanical ventilation.The primary objective of this study is to investigate the risk factors associated with the inability to liberate COVID-19 patients from mechanical ventilation. Due to the complex evolution of the disease, we analyzed both pulmonary variables and occurrence of non-pulmonary complications during mechanical ventilation. The secondary objective of this study was the evaluation of risk factors for ICU mortality.This multicenter prospective observational study enrolled 391 patients from fifteen COVID-19 dedicated Italian ICUs which underwent invasive mechanical ventilation for COVID-19 pneumonia. Clinical and laboratory data, ventilator parameters, occurrence of organ dysfunction, and outcome were recorded. The primary outcome measure was 28 days ventilator-free days and the liberation from MV at 28 days was studied by performing a competing risks regression model on data, according to the method of Fine and Gray; the event death was considered as a competing risk.Liberation from mechanical ventilation was achieved in 53.2% of the patients (208/391). Competing risks analysis, considering death as a competing event, demonstrated a decreased sub-hazard ratio for liberation from mechanical ventilation (MV) with increasing age and SOFA score at ICU admission, low values of PaO2/FiO2 ratio during the first 5 days of MV, respiratory system compliance (CRS) lower than 40 mL/cmH2O during the first 5 days of MV, need for renal replacement therapy (RRT), late-onset ventilator-associated pneumonia (VAP), and cardiovascular complications.ICU mortality during the observation period was 36.1% (141/391). Similar results were obtained by the multivariate logistic regression analysis using mortality as a dependent variable.Age, SOFA score at ICU admission, CRS, PaO2/FiO2, renal and cardiovascular complications, and late-onset VAP were all independent risk factors for prolonged mechanical ventilation in patients with COVID-19.NCT04411459.