Clinical Characteristics and Outcomes of COVID-19 Acute Respiratory Distress Syndrome Patients Requiring Invasive Mechanical Ventilation in a Lower Middle-Income Country

Abstract

Background COVID-19 related acute respiratory distress syndrome (ARDS) requires intensive care, which is highly expensive in lower-income countries. Outcomes of COVID-19 patients requiring invasive mechanical ventilation in Pakistan have not been widely reported. Identifying factors forecasting outcomes will help decide optimal care levels and prioritise resources. Methods A single-centre, retrospective study on COVID-19 patients requiring invasive mechanical ventilation was conducted from 1st March to 31st May 2020. Demographic variables, physical signs, laboratory values, ventilator parameters, complications, length of stay, and mortality were recorded. Data were analysed in SPSS ver.23. Results Among 71 study patients, 87.3% (62) were males, and 12.7% (9) were females with a mean (SD) age of 55.5(13.4) years. Diabetes mellitus and hypertension were the most common comorbidities in 54.9% (39) patients. Median(IQR) SOFA score on ICU admission and at 48 hours was 7(5-9) and 6(4-10), and median (IQR) APACHE-II score was 15 (11-24) and 13(9-23), respectively. Overall, in-hospital mortality was 57.7%; 25% (1/4), 55.6% (20/36) and 64.5% (20/31) in mild, moderate, and severe ARDS, respectively. On univariate analysis; PEEP at admission, APACHE II and SOFA score at admission and 48 hours; Acute kidney injury; D-Dimer>1.5 mg/L and higher LDH levels at 48 hours were significantly associated with mortality. Only APACHE II scores at admission and D-Dimer levels> 1.5 mg/L were independent predictors of mortality on multivariable regression (p-value 0.012 & 0.037 respectively). Admission APACHE II scores, Area under the ROC curve for mortality was 0.80 (95%CI 0.69-0.90); sensitivity was 77.5% and specificity 70% (cut-off ≥13.5). Conclusion There was a high mortality rate in severe ARDS. The APACHE II score can be utilised in mortality prediction in COVID-19 ARDS patients. However, larger-scale studies in Pakistan are required to assess predictors of mortality.

Clinical characteristics and outcomes of patients with COVID-19–associated acute respiratory distress syndrome

“…Ejaz et al [11] reported a high mortality rate in COVID-19 related acute respiratory distress syndrome (ARDS). The severity and the likelihood of developing ARDS and related adverse outcomes are linked with different factors including age more than 60 years, male sex, obesity, hypertension, diabetes mellitus, previous lung disease, and specific parameters such as low lymphocyte count and high D-dimer levels [12][13][14][15].…”

Optimizing the connection of CRRT and ECMO lines with additional pressure regulator on the therapeutic effect, filter life, and incidence of complications

“…[3] Due to the expanding range of indications for ECMO, its application has been enhanced in the intensive care unit as well as during emergency departments, operating rooms, cardiac catheterization laboratories, and interhospital transfers. [4] The patients who use ECMO generally have inflammatory hemodynamic abnormalities, inflammation, and pathophysiological abnormalities of various organs, which puts them at high risk of other organ failure. [4] The term "hyperthyroidism" is strange within the context of respiratory failure.…”

“…Patients on ECMO support have inflammatory, hemodynamic, and pathophysiological abnormalities, which put them at risk for potential complications. [4] According to current literature, 20% to 100% of ECMO acute renal injury (AKI) patients receive renal replacement therapy (RRT) before or during ECMO support. Approximately 85% of patients suffer from AKI.…”

“…[4] The patients who use ECMO generally have inflammatory hemodynamic abnormalities, inflammation, and pathophysiological abnormalities of various organs, which puts them at high risk of other organ failure. [4] The term "hyperthyroidism" is strange within the context of respiratory failure. The correct term is most likely "hypercapnia," which clearly indicates increased amounts of carbon dioxide in the bloodstream and is directly related to respiratory failure.…”

Unilateral acute lung injury in pig: a promising animal model

“…Acute respiratory distress syndrome (ARDS) is the most common pulmonary complication in critically ill patients that often results in unfavorable outcomes. Approximately two out of five patients with ARDS die [ 1 ], and the recent COVID-19 pandemic taught us that outcome of patients with ARDS due to infectious causes has not changed over recent years [ 2 , 3 ], despite significant improvements in ventilatory management and various other aspects of care for critically ill ARDS patients.…”