Short-Term Outcomes of Patients With COVID-19 Undergoing Invasive Mechanical Ventilation: A Retrospective Observational Study From Wuhan, China

Shuai Zhao; Yun Lin; Cheng Zhou; Li Wang; Xueyin Chen; Sean P Clifford; Ozan Akca; Jiapeng Huang; Xiangdong Chen

doi:10.3389/fmed.2020.571542

Short-Term Outcomes of Patients With COVID-19 Undergoing Invasive Mechanical Ventilation: A Retrospective Observational Study From Wuhan, China

Front Med (Lausanne). 2020 Sep 29:7:571542. doi: 10.3389/fmed.2020.571542. eCollection 2020.

Authors

Shuai Zhao¹, Yun Lin¹, Cheng Zhou², Li Wang¹, Xueyin Chen¹, Sean P Clifford³, Ozan Akca³, Jiapeng Huang³, Xiangdong Chen¹

Affiliations

¹ Department of Anesthesiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
² Laboratory of Anesthesia and Critical Care Medicine, Department of Anesthesiology, Translational Neuroscience Center, West China Hospital of Sichuan University, Chengdu, China.
³ Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, United States.

Abstract

Background: COVID-19 has spread rapidly worldwide. Many patients require mechanical ventilation. The goal of this study was to investigate the clinical course and outcomes of patients with COVID-19 undergoing mechanical ventilation and identify factors associated with death. Methods: Eighty-three consecutive critically ill patients with confirmed COVID-19 undergoing invasive mechanical ventilation were included in this retrospective, single-center, observational study from January 31 to March 15, 2020. Demographic, clinical, laboratory, radiological, and mechanical ventilation data were collected and analyzed. The primary outcome was 28-day mortality after endotracheal intubation. The secondary outcomes included the incidences of SARS-CoV-2-related cardiac, liver, and kidney injury. Results: Seventy-four out of 83 (89.2%) patients achieved oxygen saturation above 93% after intubation. Forty-nine out of 83 (59%) patients died and 34 (41%) patients survived after 28 days of observation. Multivariable regression showed increasing odds of death associated with cardiac injury (odds ratio 15.60, 95% CI 4.20-74.43), liver injury (5.40, 1.46-23.56), and kidney injury (8.39, 1.63-61.41), and decreasing odds of death associated with the higher PaO₂/FiO₂ ratio before intubation (0.97, 0.95-0.99). PaO₂/FiO₂ ratio before intubation demonstrated a positive linear correlation with platelet count (r = 0.424, P = 0.001), and negative linear correlation with troponin I (r = -0.395, P = 0.008). Conclusions: Cardiac, liver, and kidney injury may be associated with death for critically ill patients with COVID-19 undergoing invasive mechanical ventilation. The severity of pre-intubation hypoxia may be associated with a poorer outcome of patients with COVID-19 undergoing invasive mechanical ventilation. Larger, multi-institutional, prospective studies should be conducted to confirm these preliminary results.

Keywords: COVID-19; SARS-CoV-2; critically ill patients; invasive mechanical ventilation; outcomes.