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Observational Study
. 2021 Mar;34(2):167-175.
doi: 10.1016/j.aucc.2020.10.009. Epub 2020 Oct 27.

Mechanical ventilation and mortality among 223 critically ill patients with coronavirus disease 2019: A multicentric study in Germany

Kevin Roedl  1 , Dominik Jarczak  2 , Liina Thasler  2 , Martin Bachmann  3 , Frank Schulte  4 , Berthold Bein  5 , Christian Friedrich Weber  6 , Ulrich Schäfer  7 , Carsten Veit  8 , Hans-Peter Hauber  9 , Sebastian Kopp  10 , Karsten Sydow  11 , Andreas de Weerth  12 , Marc Bota  13 , Rüdiger Schreiber  14 , Oliver Detsch  15 , Jan-Peer Rogmann  16 , Daniel Frings  2 , Barbara Sensen  2 , Christoph Burdelski  2 , Olaf Boenisch  2 , Axel Nierhaus  2 , Geraldine de Heer  2 , Stefan Kluge  2
Affiliations
Observational Study

Mechanical ventilation and mortality among 223 critically ill patients with coronavirus disease 2019: A multicentric study in Germany

Kevin Roedl et al. Aust Crit Care. 2021 Mar.

Abstract

Background: There are large uncertainties with regard to the outcome of patients with coronavirus disease 2019 (COVID-19) and mechanical ventilation (MV). High mortality (50-97%) was proposed by some groups, leading to considerable uncertainties with regard to outcomes of critically ill patients with COVID-19.

Objectives: The aim was to investigate the characteristics and outcomes of critically ill patients with COVID-19 requiring intensive care unit (ICU) admission and MV.

Methods: A multicentre retrospective observational cohort study at 15 hospitals in Hamburg, Germany, was performed. Critically ill adult patients with COVID-19 who completed their ICU stay between February and June 2020 were included. Patient demographics, severity of illness, and ICU course were retrospectively evaluated.

Results: A total of 223 critically ill patients with COVID-19 were included. The majority, 73% (n = 163), were men; the median age was 69 (interquartile range = 58-77.5) years, with 68% (n = 151) patients having at least one chronic medical condition. Their Sequential Organ Failure Assessment score was a median of 5 (3-9) points on admission. Overall, 167 (75%) patients needed MV. Noninvasive ventilation and high-flow nasal cannula were used in 31 (14%) and 26 (12%) patients, respectively. Subsequent MV, due to noninvasive ventilation/high-flow nasal cannula therapy failure, was necessary in 46 (81%) patients. Renal replacement therapy was initiated in 33% (n = 72) of patients, and owing to severe respiratory failure, extracorporeal membrane oxygenation was necessary in 9% (n = 20) of patients. Experimental antiviral therapy was used in 9% (n = 21) of patients. Complications during the ICU stay were as follows: septic shock (40%, n = 90), heart failure (8%, n = 17), and pulmonary embolism (6%, n = 14). The length of ICU stay was a median of 13 days (5-24), and the duration of MV was 15 days (8-25). The ICU mortality was 35% (n = 78) and 44% (n = 74) among mechanically ventilated patients.

Conclusion: In this multicentre observational study of 223 critically ill patients with COVID-19, the survival to ICU discharge was 65%, and it was 56% among patients requiring MV. Patients showed high rate of septic complications during their ICU stay.

Keywords: ARDS; COVID-19; Mechanical ventilation; Mortality; Multiple organ failure; SARS-CoV-2.

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Conflict of interest statement

Conflict of Interest K.R., D.J., L.T., M.B., F.S., C.F.W., U.S., C.V., H.-P.H., S.Ko., K.S., A.d.W., M.B., R.S., O.D., J.-P.R., B.S., C.B., O.B., B.B., and G.d.H. do not report any conflicts of interest. S.K. received research support from Ambu, E.T.View Ltd., Fisher & Paykel, Pfizer, and Xenios; lecture honoraria from ArjoHuntleigh, Astellas, Astra, Basilea, Bard, Baxter, Biotest, CSL Behring, CytoSorbents, Fresenius, Gilead, MSD, Orion, Pfizer, Philips, Sedana, Sorin, Xenios, and Zoll; and consultant honorarium from AMOMED, Astellas, Baxter, Bayer, Fresenius, Gilead, MSD, Pfizer, and Xenios. A.N. received research funds, lecture honoraria, and travel reimbursement within the last 5 years from CytoSorbents Europe, Biotest AG, and Thermo Fisher Scientific. D.F. reports lecture honoraria within the last 5 years from Xenios AG.

Figures

Figure 1
Figure 1
Mortality stratified as per age in mechanically ventilated patients.
See this image and copyright information in PMC

Comment in

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