Clinical characteristics and outcomes of invasively ventilated patients with COVID-19 in Argentina (SATICOVID): a prospective, multicentre cohort study

Abstract

Background Although COVID-19 has greatly affected many low-income and middle-income countries, detailed information about patients admitted to the intensive care unit (ICU) is still scarce. Our aim was to examine ventilation characteristics and outcomes in invasively ventilated patients with COVID-19 in Argentina, an upper middle-income country. Methods In this prospective, multicentre cohort study (SATICOVID), we enrolled patients aged 18 years or older with RT-PCR-confirmed COVID-19 who were on invasive mechanical ventilation and admitted to one of 63 ICUs in Argentina. Patient demographics and clinical, laboratory, and general management variables were collected on day 1 (ICU admission); physiological respiratory and ventilation variables were collected on days 1, 3, and 7. The primary outcome was all-cause in-hospital mortality. All patients were followed until death in hospital or hospital discharge, whichever occurred first. Secondary outcomes were ICU mortality, identification of independent predictors of mortality, duration of invasive mechanical ventilation, and patterns of change in physiological respiratory and mechanical ventilation variables. The study is registered with ClinicalTrials.gov , NCT04611269 , and is complete. Findings Between March 20, 2020, and Oct 31, 2020, we enrolled 1909 invasively ventilated patients with COVID-19, with a median age of 62 years [IQR 52–70]. 1294 (67·8%) were men, hypertension and obesity were the main comorbidities, and 939 (49·2%) patients required vasopressors. Lung-protective ventilation was widely used and median duration of ventilation was 13 days (IQR 7–22). Median tidal volume was 6·1 mL/kg predicted bodyweight (IQR 6·0–7·0) on day 1, and the value increased significantly up to day 7; positive end-expiratory pressure was 10 cm H 2 O (8–12) on day 1, with a slight but significant decrease to day 7. Ratio of partial pressure of arterial oxygen (PaO 2 ) to fractional inspired oxygen (FiO 2 ) was 160 (IQR 111–218), respiratory system compliance 36 mL/cm H 2 O (29–44), driving pressure 12 cm H 2 O (10–14), and FiO 2 0·60 (0·45–0·80) on day 1. Acute respiratory distress syndrome developed in 1672 (87·6%) of patients; 1176 (61·6%) received prone positioning. In-hospital mortality was 57·7% (1101/1909 patients) and ICU mortality was 57·0% (1088/1909 patients); 462 (43·8%) patients died of refractory hypoxaemia, frequently overlapping with septic shock (n=174). Cox regression identified age (hazard ratio 1·02 [95% CI 1·01–1·03]), Charlson score (1·16 [1·11–1·23]), endotracheal intubation outside of the ICU (ie, before ICU admission; 1·37 [1·10–1·71]), vasopressor use on day 1 (1·29 [1·07–1·55]), D-dimer concentration (1·02 [1·01–1·03]), PaO 2 /FiO ...

Patients With Coronavirus Disease 2019 Requiring Invasive Mechanical Ventilation in Mexico in the First, Second, and Exponential Growth Phase of the Third Wave of the Coronavirus Disease 2019 Pandemic

“…In this report, the inhospital mortality of hospitalized COVID-19 patients requiring IMV was higher than that of other countries such as Brazil ( 4 ) (81.5% vs 83.7%; p < 0.001). Recently, Estenssoro et al ( 5 ) reported that 22% of patients who required intubation in Argentina were outside the ICU; this proportion is much lower than that presented in this report (22% vs 68.5%; p < 0.001). In Mexico, the Secretary of Health designed a hospital reconversion system in which the work groups for the care of critically ill patients include one specialist physician as the leader of medical and nursing areas, guiding the staff with national and international guidelines for managing critically ill patients with COVID-19.…”

The Risk Factors for Weaning Failure of Mechanically Ventilated Patients With COVID-19: A Retrospective Study in National Medical Team Work

“…Actually, recent data ( 21 ) have demonstrated that there is no safe upper limit for DP; the slope of the relationship between DP and mortality appears to be positive even at DP below 14 cmH 2 O, suggesting that patient outcomes may be improved with the decreasing DP. The SATICOVID study also showed that DP was strongly associated with mortality ( 22 ). Regardless of whether it is due to the high peep or DP, a high Pplat (close to 30 cmH 2 O) is an important cause for alarm for clinicians.…”

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“…Identifying at-risk patients is crucial for providing care and determining resource allocation based on patient risk stratification. Endotracheal intubation in SARS-CoV-2 has been associated with a higher risk of mortality [ 4 ], and determining an efficient way of identifying patients who are likely to require intubation would assist in providing enhanced care and prioritizing resources in a high-demand and limited-resource setting [ 5 ].…”