Background
Remdesivir has been associated with accelerated recovery of severe COVID-19. However, whether it is beneficial also in patients requiring mechanical ventilation is uncertain.
Methods
All consecutive 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 as 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.
Results
113 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 hospital. Among 33 treated with RDV, lower mortality (15.2% versus 38.8%), higher rates of extubation (88% versus 60%), ventilator-free days (in median, 11 [IQR 0-16] versus 5 [IQR 0-14.5]) and hospital discharge (85% versus 59%) were observed. Using multivariable analysis, RDV was significantly associated with hospital discharge (HR 2.25; 95%CI 1.27-3.97; P=0.005) and to a non-significantly lower mortality (HR 0.73; 95%CI 0.26-2.1; P=0.560). RDV was also independently associated with extubation (HR 2.10; 95%CI 1.19-3.73; P=0.011), considered as a competing risk to death in ICU, in an additional survival model.
Conclusion
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, independently of other risk factors.
Functional residual capacity is affected by PEEP. Ignoring this effect leads to relevant underestimation of alveolar recruitment as measure by pressure-volume curve displacement.
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