Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs.
Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs.
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DOI：
10.1186/s40560-020-00499-4
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发表时间：
2020
影响因子：
7.1
通讯作者：
ICU-RER COVID-19 Collaboration
中科院分区：
文献类型：
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作者：
Gamberini L;Tonetti T;Spadaro S;Zani G;Mazzoli CA;Capozzi C;Giampalma E;Bacchi Reggiani ML;Bertellini E;Castelli A;Cavalli I;Colombo D;Crimaldi F;Damiani F;Fogagnolo A;Fusari M;Gamberini E;Gordini G;Laici C;Lanza MC;Leo M;Marudi A;Nardi G;Ottaviani I;Papa R;Potalivo A;Russo E;Taddei S;Volta CA;Ranieri VM;ICU-RER COVID-19 Collaboration
很大比例的冠状病毒病2019(新冠肺炎)患者发展为严重呼吸衰竭，需要进入重症监护病房(ICU)，其中约80%需要机械通气(MV)。由于多器官受累和随时间的动态演变，这些患者表现出极大的复杂性；此外，关于可能导致机械通气时间延长的危险因素的信息很少。本研究的主要目的是探讨无法将新冠肺炎患者从机械通气中解脱出来的危险因素。由于疾病的复杂演变，我们分析了机械通气过程中肺部变量和非肺源性并发症的发生情况。这项研究的次要目标是评估ICU死亡率的危险因素。这项多中心前瞻性观察研究纳入了来自15个新冠肺炎专用意大利ICU的391名患者，这些ICU接受了有创机械通气治疗新冠肺炎肺炎。记录临床和实验室数据、呼吸机参数、器官功能障碍的发生率和转归。主要结果测量为28 天无呼吸机天数，根据Fine和Gray方法对数据进行竞争风险回归模型研究28 天脱离MV的情况；事件死亡被视为竞争风险。391例患者中53.2%(208/391)成功脱离机械通气。将死亡视为竞争事件的竞争风险分析显示，随着ICU入院时年龄和SOFA评分的增加，脱离机械通气(MV)的亚危率降低，MV前5 内PaO2/FiO2比值较低，MV前5 d内呼吸系统顺应性低于40 cmH2O，需要肾脏替代治疗，晚发性呼吸机相关肺炎和心血管并发症。观察期ICU病死率为36.1%(141/391)。以死亡率为因变量的多变量Logistic回归分析也得到了类似的结果。年龄、入院时SOFA评分、CRS、PaO2/FiO2、肾脏和心血管并发症、晚发型呼吸机相关性肺炎是新冠肺炎患者机械通气时间延长的独立危险因素。NCT04411459
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. 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. 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. 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. NCT04411459