Outcomes Among Mechanically Ventilated Patients With Severe Pneumonia and Acute Hypoxemic Respiratory Failure From SARS-CoV-2 and Other Etiologies.
Outcomes Among Mechanically Ventilated Patients With Severe Pneumonia and Acute Hypoxemic Respiratory Failure From SARS-CoV-2 and Other Etiologies.
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SARS-COV-2和其他病因的机械通风患者和急性低氧呼吸衰竭的机械通风患者的结局。
DOI：
10.1001/jamanetworkopen.2022.50401
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发表时间：
2023-01-03
影响因子：
13.8
通讯作者：
Checkley, William
中科院分区：
文献类型：
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作者：
Nolley, Eric P.;Sahetya, Sarina K.;Hochberg, Chad H.;Hossen, Shakir;Hager, David N.;Brower, Roy G.;Stuart, Elizabeth A.;Checkley, William
新冠肺炎肺炎的死亡率是否高于其他肺炎原因？在这项对1,846名肺炎患者的队列研究中，新冠肺炎肺炎与其他肺炎原因具有相似的死亡率和生理表型。这些发现表明，新冠肺炎肺炎的机械通气治疗应该遵循与任何肺炎相同的循证指南。这项队列研究比较了由新冠肺炎和其他原因引起的肺炎机械通气患者的结果。早期观察表明，新冠肺炎肺炎的死亡率高于其他肺炎原因。比较新冠肺炎所致机械通气肺炎患者(2020年3月至2021年6月)与其他原因肺炎患者(2016年7月至2019年12月)的预后。这项回顾性队列研究是在约翰霍普金斯大学医疗保健系统中进行的，研究对象为成年肺炎患者(年龄18岁，≥)，他们在入院后的头两周需要机械通气。临床、实验室和机械通气数据从入院到出院或死亡。新冠肺炎所致肺炎。主要结果是90天的住院死亡率。次要结果是从机械通气中解脱出来的时间、住院时间、静态呼吸系统顺应性和通气率。未调整和多变量调整的Logistic回归、比例风险回归和双稳健回归被用于倾向得分匹配集以比较临床结果。总体而言，719例重症新冠肺炎肺炎患者(平均年龄61.8[15.3]岁；442例(61.5%)男性；460例(64.0%)属于小化种族，253例(35.2%)为白人)和1127例(平均[SD]年龄60.9[15.8]岁；586例(52.0%)男性；459例(40.7%)属于小化种族，655例(58.1%)为白人)。在非校正分析中，新冠肺炎肺炎患者较非新冠肺炎肺炎患者有更高的90d死亡率(优势比，1.21，95%可信区间1.04~1.41)、更长的机械通气时间(再分布风险比0.72，95%可信区间0.63~0.81)和更低的依从性(32.0vs28.4mL/kg PBW/cm H2O；P <； .001)。在倾向得分匹配分析中，新冠肺炎肺炎患者与非新冠肺炎肺炎患者在90天内死亡的可能性相同(优势比，1.04；95%CI，0.81至1.35；P = .85)，具有相似的呼吸系统顺应性(平均差异，1.82毫升/厘米水；95%可信区间，−1.53至5.17毫升/厘米水；P = 0.28)和呼吸机比率(平均差异，−0.05；95%可信区间，−0.22至0.11；P = .52)，但与非新冠肺炎肺炎组相比，机械通气组的机械通气率较低(分布危险度比为0.81；95%可信区间为0.65~1.00)。新冠肺炎肺炎患者在90天内的出院率略低于非新冠肺炎肺炎患者(分布危险度比为0.83；95%CI为0.68至1.01)；但这在统计学上并不显著。在这项研究中，机械通气的重症新冠肺炎肺炎患者的死亡率与其他原因的重症肺炎患者相似，但从机械通气中解脱出来的时间更长。新冠肺炎肺炎的机械通气治疗应遵循与任何肺炎相同的循证指南。
Does COVID-19 pneumonia have a higher mortality rate than other causes of pneumonia? In this cohort study of 1846 patients with pneumonia, COVID-19 pneumonia had similar mortality rates and physiologic phenotypes as other causes of pneumonia. These findings suggest that mechanical ventilation use in COVID-19 pneumonia should follow the same evidence-based guidelines as any pneumonia. This cohort study compares outcomes between mechanically ventilated patients with pneumonia due to COVID-19 and other etiologies. Early observations suggested that COVID-19 pneumonia had a higher mortality rate than other causes of pneumonia. To compare outcomes between mechanically ventilated patients with pneumonia due to COVID-19 (March 2020 to June 2021) and other etiologies (July 2016 to December 2019). This retrospective cohort study was conducted at the Johns Hopkins Healthcare System among adult patients (aged ≥18 years) with pneumonia who required mechanical ventilation in the first 2 weeks of hospitalization. Clinical, laboratory, and mechanical ventilation data were extracted from admission to hospital discharge or death. Pneumonia due to COVID-19. The primary outcome was 90-day in-hospital mortality. Secondary outcomes were time to liberation from mechanical ventilation, hospital length of stay, static respiratory system compliance, and ventilatory ratio. Unadjusted and multivariable-adjusted logistic regression, proportional hazards regression, and doubly robust regression were used in propensity score–matched sets to compare clinical outcomes. Overall, 719 patients (mean [SD] age, 61.8 [15.3] years; 442 [61.5%] were male; 460 [64.0%] belonged to a minoritized racial group and 253 [35.2%] were White) with severe COVID-19 pneumonia and 1127 patients (mean [SD] age, 60.9 [15.8] years; 586 [52.0%] were male; 459 [40.7%] belonged to a minoritized racial group and 655 [58.1%] were White) with severe non–COVID-19 pneumonia. In unadjusted analyses, patients with COVID-19 pneumonia had higher 90-day mortality (odds ratio, 1.21, 95% CI 1.04-1.41), longer time on mechanical ventilation (subdistribution hazard ratio 0.72, 95% CI 0.63-0.81), and lower compliance (32.0 vs 28.4 mL/kg PBW/cm H2O; P < .001) when compared with those with non–COVID-19 pneumonia. In propensity score–matched analyses, patients with COVID-19 pneumonia were equally likely to die within 90 days as those with non–COVID-19 pneumonia (odds ratio, 1.04; 95% CI, 0.81 to 1.35; P = .85), had similar respiratory system compliance (mean difference, 1.82 mL/cm H2O; 95% CI, −1.53 to 5.17 mL/cm H2O; P = .28) and ventilatory ratio (mean difference, −0.05; 95% CI, −0.22 to 0.11; P = .52), but had lower rates of liberation from mechanical ventilation (subdistribution hazard ratio, 0.81; 95% CI, 0.65 to 1.00) when compared with those with non–COVID-19 pneumonia. Patients with COVID-19 pneumonia had somewhat lower rates of being discharged from the hospital alive at 90 days (subdistribution hazard ratio, 0.83; 95% CI, 0.68 to 1.01) than those with non–COVID-19 pneumonia; however, this was not statistically significant. In this study, mechanically ventilated patients with severe COVID-19 pneumonia had similar mortality rates as patients with other causes of severe pneumonia but longer times to liberation from mechanical ventilation. Mechanical ventilation use in COVID-19 pneumonia should follow the same evidence-based guidelines as for any pneumonia.
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影响因子：
8.3
作者：
Cobb NL;Sathe NA;Duan KI;Seitz KP;Thau MR;Sung CC;Morrell ED;Mikacenic C;Kim HN;Liles WC;Luks AM;Town J;Pipavath S;Wurfel MM;Hough CL;West TE;Bhatraju PK
通讯作者：
Bhatraju PK
影响因子：
38.9
作者：
COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators
通讯作者：
COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators
DOI：
10.1186/s13054-021-03665-8
发表时间：
2021-07-15
期刊：
Critical care (London, England)
影响因子：
--
作者：
Beloncle F;Studer A;Seegers V;Richard JC;Desprez C;Fage N;Merdji H;Pavlovsky B;Helms J;Cunat S;Mortaza S;Demiselle J;Brochard L;Mercat A;Meziani F
通讯作者：
Meziani F
影响因子：
38.9
作者：
Ferrando, Carlos;Suarez-Sipmann, Fernando;Villar, Jesus
通讯作者：
Villar, Jesus
影响因子：
15.1
作者：
Grieco, Domenico Luca;Bongiovanni, Filippo;Antonelli, Massimo
通讯作者：
Antonelli, Massimo