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. 2021 Oct 2;11(1):143.
doi: 10.1186/s13613-021-00929-y.

Long-term survival of mechanically ventilated patients with severe COVID-19: an observational cohort study

Oscar Peñuelas  1   2 , Laura Del Campo-Albendea  3 , Amanda Lesmes González de Aledo  4 , José Manuel Añón  5   6 , Carmen Rodríguez-Solís  7 , Jordi Mancebo  8 , Paula Vera  8 , Daniel Ballesteros  9 , Jorge Jiménez  7 , Emilio Maseda  10 , Juan Carlos Figueira  5   6 , Nieves Franco  11 , Ángela Algaba  12 , Juan Pablo Avilés  13 , Ricardo Díaz  13 , Beatriz Abad  14 , Alfonso Canabal  14 , Ana Abella  15 , Federico Gordo  15 , Javier García  16 , Jessica García Suarez  16 , Jamil Cedeño  17 , Basilia Martínez-Palacios  18 , Eva Manteiga  18 , Óscar Martínez  19 , Rafael Blancas  19 , Tommaso Bardi  20 , David Pestaña  20 , José Ángel Lorente  7   5 , Alfonso Muriel  3 , Andrés Esteban  7 , Fernando Frutos-Vivar  7
Affiliations

Long-term survival of mechanically ventilated patients with severe COVID-19: an observational cohort study

Oscar Peñuelas et al. Ann Intensive Care. .

Abstract

Background: Information is lacking regarding long-term survival and predictive factors for mortality in patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) and undergoing invasive mechanical ventilation. We aimed to estimate 180-day mortality of patients with COVID-19 requiring invasive ventilation, and to develop a predictive model for long-term mortality.

Methods: Retrospective, multicentre, national cohort study between March 8 and April 30, 2020 in 16 intensive care units (ICU) in Spain. Participants were consecutive adults who received invasive mechanical ventilation for COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection detected in positive testing of a nasopharyngeal sample and confirmed by real time reverse-transcriptase polymerase chain reaction (rt-PCR). The primary outcomes was 180-day survival after hospital admission. Secondary outcomes were length of ICU and hospital stay, and ICU and in-hospital mortality. A predictive model was developed to estimate the probability of 180-day mortality.

Results: 868 patients were included (median age, 64 years [interquartile range [IQR], 56-71 years]; 72% male). Severity at ICU admission, estimated by SAPS3, was 56 points [IQR 50-63]. Prior to intubation, 26% received some type of noninvasive respiratory support. The unadjusted overall 180-day survival rates was 59% (95% CI 56-62%). The predictive factors measured during ICU stay, and associated with 180-day mortality were: age [Odds Ratio [OR] per 1-year increase 1.051, 95% CI 1.033-1.068)), SAPS3 (OR per 1-point increase 1.027, 95% CI 1.011-1.044), diabetes (OR 1.546, 95% CI 1.085-2.204), neutrophils to lymphocytes ratio (OR per 1-unit increase 1.008, 95% CI 1.001-1.016), failed attempt of noninvasive positive pressure ventilation prior to orotracheal intubation (OR 1.878 (95% CI 1.124-3.140), use of selective digestive decontamination strategy during ICU stay (OR 0.590 (95% CI 0.358-0.972) and administration of low dosage of corticosteroids (methylprednisolone 1 mg/kg) (OR 2.042 (95% CI 1.205-3.460).

Conclusion: The long-term survival of mechanically ventilated patients with severe COVID-19 reaches more than 50% and may help to provide individualized risk stratification and potential treatments.

Trial registration: ClinicalTrials.gov Identifier: NCT04379258. Registered 10 April 2020 (retrospectively registered).

Keywords: ARDS; COVID-19; Coronavirus disease 2019; Intensive care unit; Invasive mechanical ventilation; Mortality; Noninvasive ventilation; Pneumonia; SARS-CoV-2.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curves. Overall survival at 180 days. Grey lines represent the 95% confidence interval
Fig. 2
Fig. 2
Multivariable-adjusted risk model for death at 180 days and forest plot
See this image and copyright information in PMC

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