АНАЛИЗ ЛЕТАЛЬНОСТИ В ГРУППЕ БОЛЬНЫХ С COVID-19 В ОТДЕЛЕНИИ РЕАНИМАЦИИ И ИНТЕНСИВНОЙ ТЕРАПИИ

Abstract

Considering the high incidence of COVID-19, the high need for respiratory replacement therapy in severe patients with simultaneously high mortality rates, especially in the group of patients over 50 years of age; to optimize intensive care, it seems relevant to identify factors influencing mortality in patients receiving various types of respiratory support. Aim: to identify the effect of different types of respiratory support on mortality in patients with COVID-19 viral pneumonia during treatment in the intensive care unit. Materials and methods. Study design: retrospective, observational, single-center, for the period 2021. Inclusion criteria: probable and PCR-confirmed infection, the volume of lung tissue damage is more than 50%, clinically justified need for respiratory support. Exclusion criteria: age under 50 years, stay in the intensive care unit for less than 24 hours, acute surgical pathology. Pregnancy. Endpoint of the study: transfer to the general department with improvement of condition, death. Intermediate (surrogate) study points: time before transfer to artificial lung ventilation (days), number of re-intubations, timing of non-invasive and invasive artificial lung ventilation (ALV). 130 patients met inclusion criteria; the formed groups according to the factor of the methods of respiratory therapy used consisted of 65 (50%) patients who received ALV and 65 (50%) - respiratory support without ALV. In addition to descriptive statistics, the risk factor for an unfavorable outcome was determined by calculating the odds ratio based on the use of artificial lung ventilation with a 95% confidence interval. Results: Of the 65 patients who underwent ALV, 61 died (93.8%), in the group without ALV – 19 people (29.2%). Number of intubations – 68; 3 re-intubations in the group of deceased patients (4.6%). The duration of non-invasive methods of respiratory support before intubation and ALV was 3.7 [2.1-5.9]. The odds ratio for death with ALV was 14,000 (95% CI: 1,135-17,265); relative risk (RR) – 2.857 (CI 95%: 1.058 – 7.719). Conclusion. The types of respiratory support themselves (artificial lung ventilation or non-invasive methods) are not factors of direct influence leading to an increase in mortality. The choice of respiratory therapy method is more determined by the effectiveness of hypoxemia compensation. An increase in the oxygenation index of more than 180 mm Hg on the first day, followed by stabilization and a positive increase in values in the range of 180-320 mm Hg is a marker of effective respiratory therapy and an indicator of the sufficiency of the support method used.