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

  1. Christopher S. King
  2. Dhwani Sahjwani
  3. A. Whitney Brown
  4. Saad Feroz
  5. Paula Cameron
  6. Erik Osborn
  7. Mehul Desai
  8. Svetolik Djurkovic
  9. Aditya Kasarabada
  10. Rachel Hinerman
  11. James Lantry
  12. Oksana A. Shlobin
  13. Kareem Ahmad
  14. Vikramjit Khangoora
  15. Shambhu Aryal
  16. A. Claire Collins
  17. Alan Speir
  18. Steven Nathan

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Abstract

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.

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  1. Version published to 10.1371/journal.pone.0242651
  2. ScreenIT

    SciScore for 10.1101/2020.07.16.20155580: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was approved by the institutional review board (IRB # U20-05-4061).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical analyses were performed using STATA version 12 (StataCorp LP; College Station, TX, USA).
    STATA
    suggested: (Stata, RRID:SCR_012763)
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study does have some limitations which should be acknowledged. First, the follow-up remains incomplete so we cannot provide conclusive outcome data. That being said, our study provides definitive outcomes data in over 60% of the cohort. We have additionally provided data on the rate of successful extubation, which has not been reported in other studies. Although ongoing follow-up would allow for definitive conclusions, we felt it was important to provide data regarding outcomes from a well-resourced, health system in a developed country. The need for additional outcomes data on IMV outcomes in COVID-19 patients was well expressed in a recent manuscript by Dr. Hannah Wunsch. (10) As she points out, prior publications with shockingly high mortality make for provocative headlines in the lay press, but may be doing a disservice to the medical community. They may invoke unjustified feelings of futility in bedside providers and prevent poorly resourced facilities from offering potentially life-saving advanced therapies. They may also prevent patients and families from accepting intensive therapies which could be potentially life-saving. Therefore, we feel our manuscript is an important addition to the available literature on outcomes of critically ill COVID-19 patients. Another limitation of our study is that it may not be generalizable to all health systems. Our health care system has a well-resourced, well-structured and dedicated medical critical care service with high volum...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.07.16.20155580v1 on medRxiv