Risk Factors and Outcomes Associated With Re-Intubation Secondary to Respiratory Failure in Patients With COVID-19 ARDS.

Autor:	Halaseh RM; Pulmonary and Critical Care Department, Cleveland Clinic Florida, Weston, Florida. halaser@ccf.org., Drescher GS; Respiratory Therapy Department, MedStar Washington Hospital Center, Washington, District of Columbia., Al-Ahmad M; Internal Medicine Department, University of Florida Health, Gainesville, Florida., Masri IH; Pulmonary and Critical Care Department, MedStar Washington Hospital Center, Washington, District of Columbia., Alayon AL; Neurology Department, University of Miami, Miami, Florida., Ghawanmeh M; Cardiology Department, George Washington University Hospital, Washington, District of Columbia., Arar T; Internal Medicine Department, MedStar Washington Hospital Center, Washington, District of Columbia., Mohammad SA; Internal Medicine Department, MedStar Washington Hospital Center, Washington, District of Columbia., Pavate R; Internal Medicine Department, MedStar Washington Hospital Center, Washington, District of Columbia., Bakri MH; Internal Medicine Department, University of Florida Health, Gainesville, Florida., Al-Tarbsheh A; Pulmonary and Critical Care Department, Cleveland Clinic Florida, Weston, Florida., AlGhadir-AlKhalaileh M; Internal Medicine Department, Cleveland Clinic Florida, Weston, Florida.
Jazyk:	angličtina
Zdroj:	Respiratory care [Respir Care] 2023 Jul 12. Date of Electronic Publication: 2023 Jul 12.
DOI:	10.4187/respcare.10881
Abstrakt:	Background: COVID-19 is associated with variable symptoms and clinical sequelae. Studies have examined the clinical course of these patients, finding a prolonged need for invasive ventilation and variable re-intubation rates. However, no research has investigated factors and outcomes related to re-intubation secondary to respiratory failure among patients with COVID-19 with ARDS. Methods: We conducted a single-center, retrospective study on subjects intubated for ARDS secondary to COVID-19. The primary outcome was re-intubation status; secondary outcomes were hospital and ICU stay and mortality. Data were analyzed using between-group comparisons using chi-square testing for categorical information and Student t test for quantitative data. Univariate and multivariate logistic regression was performed to determine factors related to re-intubation and mortality as dependent variables. Results: One hundred and fourteen subjects were included, of which 32% required re-intubation. No between-group differences were detected for most demographic variables or comorbidities. No differences were detected in COVID-19 treatments, noninvasive respiratory support, mechanical circulatory support, or duration of ventilation. Midazolam (odds ratio [OR] 5.55 [95% CI 1.83-16.80] , P = .002), fentanyl (OR 3.64 [95% CI 1.26-10.52] , P = .02), and APACHE II scores (OR 1.08 [95% CI 1.030-1.147] , P = .005) were independently associated with re-intubation (area under the curve = 0.81). Re-intubated subjects had extended hospital (36.7 ± 22.7 d vs 26.1 ± 12.1 d , P = .01) and ICU (29.6 ± 22.4 d vs 15.8 ± 10.4 d , P < .001) stays. More subjects died who failed extubation (49% vs 3% , P < .001). Age (OR 1.07 [95% CI 1.02-1.23] , P = .005), male sex (OR 4.9 [95% CI 1.08-22.35] , P = .041), positive Confusion Assessment Method for the ICU (CAM-ICU) (OR 5.43 [95% CI 1.58-18.62] , P = .007), and re-intubation (OR 12.75 [95% CI 2.80-57.10] , P < .001) were independently associated with death (area under the curve = 0.93). Conclusions: Midazolam, fentanyl, and higher APACHE II scores were independently associated with re-intubation secondary to respiratory failure in subjects with COVID-19-related ARDS. Furthermore, age, male sex, positive CAM-ICU, and re-intubation were independently associated with mortality. Re-intubation also correlated with prolonged hospital and ICU stay. (Copyright © 2023 by Daedalus Enterprises.)
Databáze:	MEDLINE
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