Outcomes of mechanically ventilated patients with COVID-19 associated respiratory failure

Abstract

Purpose The outcomes of patients requiring invasive mechanical ventilation for COVID-19 remain poorly defined. We sought to determine clinical characteristics and outcomes of patients with COVID-19 managed with invasive mechanical ventilation in an appropriately resourced US health care system. Methods Outcomes of COVID-19 infected patients requiring mechanical ventilation treated within the Inova Health System between March 5, 2020 and April 26, 2020 were evaluated through an electronic medical record review. Results 1023 COVID-19 positive patients were admitted to the Inova Health System during the study period. Of these, 164 (16.0%) were managed with invasive mechanical ventilation. All patients were followed to definitive disposition. 70/164 patients (42.7%) had died and 94/164 (57.3%) were still alive. Deceased patients were older (median age of 66 vs. 55, p <0.0001) and had a higher initial d-dimer (2.22 vs. 1.31, p = 0.005) and peak ferritin levels (2998 vs. 2077, p = 0.016) compared to survivors. 84.3% of patients over 70 years old died in the hospital. Conversely, 67.4% of patients age 70 or younger survived to hospital discharge. Younger age, non-Caucasian race and treatment at a tertiary care center were all associated with survivor status. Conclusion Mortality of patients with COVID-19 requiring invasive mechanical ventilation is high, with particularly daunting mortality seen in patients of advanced age, even in a well-resourced health care system. A substantial proportion of patients requiring invasive mechanical ventilation were not of advanced age, and this group had a reasonable chance for recovery.

Outcome of Instrumental Oxygen Therapy in COVID-19: Survivors Versus Non-survivors in Bangladeshi Cohort

“…The overall mortality rate in ICU was 39.39% in the present study, which was almost similar to the findings of King et al (40%) [11]. The mortality rate of COVID-19 patients in ICU was almost similar in China, Italy, and Denmark with 37.7%, 25.6%, and 41.2% respectively in different studies [12].…”

“…Patients of advanced age account for the majority of death in the present study. A similar observation was reported in another study done on 164patients in the USA admitted in ICU, the highest 33% cases were seen in the 51-60 age group (survivors) and 38.6% cases in the above 70-year group (nonsurvivors) [11]. In a Mexican study, 39.6% of patients who were above 65 years of age were non-survivors, whereas survivors (37.6%) were in the 35-54 age group [15].…”

“…There is a lack of clarity about the prognosis and intervention of COVID-19 patients with acute respiratory failure requiring invasive mechanical ventilation. The mortality rate ranges from 16%-97% in different clinical studies globally [11]. Studies in the USA reported 12.2% and 57.3% of patients in ICU required invasive mechanical ventilation [11,19].…”

“…The mortality rate ranges from 16%-97% in different clinical studies globally [11]. Studies in the USA reported 12.2% and 57.3% of patients in ICU required invasive mechanical ventilation [11,19]. In Japan, a study on 1553 hospitalized COVID patients in 18 Japanese hospitals, 125 patients of which received invasive mechanical ventilation with a 24% mortality rate [20].…”

Clinical outcomes and characteristics of patients hospitalized for Influenza or COVID-19 in Germany

“…In our study, 15% (n = 362) of COVID-19 and only 9% (n = 610) of Influenza cases required ventilation. This corresponds to recent studies on hospitalized patients with COVID-19 showing that between 12% and 17% of patients required MV ( Karagiannidis et al, 2020 , King et al, 2020 , Richardson et al, 2020 ). The reported 9% of ventilated patients treated with ECMO is in line with published results and gives an estimate of ECMO treatment in patients with COVID-19 in Germany ( Karagiannidis et al, 2020 , King et al, 2020 ).…”