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

Abstract

Background 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. Methods 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. Results 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. Conclusions 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. Trial registration NCT04411459

Impact of Convalescent Plasma Transfusion (CCP) In Patients With Previous Circulating Neutralizing Antibodies (nAb) to COVID-19

“…However, these findings were not reproducible in the duration of mechanical ventilation. Our data partially differs from Gamberini et al ,, who demonstrated that age, SOFA score at ICU admission, PaO 2 /FiO 2 , renal and cardiovascular complications, and late-onset VAP were all independent risk factors for prolonged mechanical ventilation in patients with COVID-19 [40]. Differences found may be due to the low number of patients analyzed and different methodologies implemented.…”

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

“…Following publication of the original article [ 1 ], the authors identified an error in the collaborator author’s name of Elena Mosconi.…”

Fatal COVID-19 and non-COVID-19 Acute Respiratory Distress Syndrome is Associated with Incomplete Alveolar Type 1 Epithelial Cell Differentiation from the Transitional State Without Fibrosis

“…Signaling pathways differentially activated in the transitional and AEC1 states, including TGFβ, Sox4 and TNF (12–14), are plausible candidates. Although COVID-19 ARDS may be associated with worse outcomes than ARDS from other etiologies (1–3), we suspect that this pathology is common to severe ARDS regardless of etiology.…”

“…In its most severe form, COVID-19 manifests as the acute respiratory distress syndrome (ARDS). COVID-19 ARDS causes acute respiratory failure associated with prolonged ventilator dependence and high mortality rates (1–3). However, the underlying mechanism by which COVID-19 ARDS results in prolonged ventilator dependence and high mortality is unknown.…”