Predicting Risk Score for Mechanical Ventilation in Hospitalized Adult Patients Suffering from COVID-19

Abstract

Background: COVID-19 has become a pandemic since December 2019, causing millions of deaths worldwide. It has a wide spectrum of severity, ranging from mild infection to severe illness requiring mechanical ventilation. In the middle of a pandemic, when medical resources (including mechanical ventilators) are scarce, there should be a scoring system to provide the clinicians with the information needed for clinical decision-making and resource allocation. Objectives: This study aimed to develop a scoring system based on the data obtained on admission, to predict the need for mechanical ventilation in COVID-19 patients. Methods: This study included COVID-19 patients admitted to Sina Hospital, Tehran University of Medical Sciences from February 20 to May 29, 2020. Patients' data on admission were retrospectively recruited from Sina Hospital COVID-19 Registry (SHCo-19R). Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed to identify the predictive factors for mechanical ventilation. Results: A total of 681 patients were included in the study; 74 patients (10.9%) needed mechanical ventilation during hospitalization, while 607 (89.1%) did not. Multivariate logistic analysis revealed that age (OR,1.049; 95% CI:1.008-1.09), history of diabetes mellitus (OR,3.216; 95% CI:1.134-9.120), respiratory rate (OR,1.051; 95% CI:1.005-1.100), oxygen saturation (OR,0.928; 95% CI:0.872-0.989), CRP (OR,1.013; 95% CI:1.001-1.024) and bicarbonate level (OR,0.886; 95% CI:0.790-0.995) were risk factors for mechanical ventilation during hospitalization. Conclusions: A risk score has been developed based on the available data within the first hours of hospital admission to predict the need for mechanical ventilation. This risk score should be further validated to determine its applicability in other populations.

Invasive Airway "Intubation" in COVID-19 Patients; Statistics, Causes, and Recommendations: A Review Article

“…Several factors are associated with intubation in COVID-19 patients. Elderly patients, male patients, and those with background diseases, particularly hypertension and diabetes, are more at risk of intubation (1,15,35,56). Also, chest CT scan and respiratory rate are important prognostic factors in determining the severity of the disease and overall prognosis (59).…”

“…According to recent studies, more than 10% of COVID-19 patients in northern Italy who suffered from hypoxia were intubated in the ICU (14). It is reported that old age, diabetes mellitus, respiratory rate, increased level of C-reactive protein, bicarbonate level, and oxygen saturation are the most valuable predictors of the need for mechanical ventilation (15). One of the distinguishing characteristics of hypoxia in COVID-19 patients is "the happy hypoxic", which means that the patient is mentally alert and there is no significant respiratory distress, but low blood oxygen saturation can be developed (16).…”

An Umbrella Review of Clinical Efficacy and Adverse Cardiac Events Associated with Hydroxychloroquine or Chloroquine with or Without Azithromycin in Patients with COVID-19

“…been conducted globally to discover a feasible, effective treatment. Unfortunately, critically ill and mechanically ventilated patients suffering COVID-19 show an overall higher mortality rate (10)(11)(12). Although vaccine development offers a glimmer of hope to end the current appalling pandemic, there is still a lack of definitive therapy, particularly for SARS-CoV-2-induced pneumonia (13).…”

COVID-19 Is Not Over and Needs Prediction Scores: An Endless Road!

“…The lung mechanic indices are well-preserved in the first days of the disease, and there is no increased airway resistance or dead space ventilation; thus, the respiratory center does not sense an uncomfortable sensation of breathing. Considering ARDS as the most common reason for mortality in COVID-19 patients and concurrent happy/silent hypoxemia on the first day of the disease, it seems that prediction scores that rely on pulmonary variables (such as partial pressure of oxygen [Pao 2 ], Pao 2 /fraction of inspired oxygen [Fio 2 ]) can be misleading in diagnosing the severe/critically ill COVID-19 patients (12)(13)(14)(15).…”