Abstract
Acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) pneumonia is the main cause of the pandemic’s death toll. The assessment of ARDS and time on invasive mechanical ventilation (IMV) could enhance the characterization of outcomes and management of this condition. This is a city-wide retrospective study of hospitalized patients with COVID-19 pneumonia from 5 March 2020 to 30 June 2020. Patients with critical illness were compared with those with non-critical illness. We examined the severity of ARDS and other factors associated with (i) weaning patients off IMV and (ii) mortality in a city-wide study in Louisville, KY. Of 522 patients with COVID-19 pneumonia, 219 (41.9%) were critically ill. Among critically ill patients, the median age was 60 years; 53% were male, 55% were White and 32% were African American. Of all critically ill patients, 52% had ARDS, and 38% of these had severe ARDS. Of the 25% of patients who were weaned off IMV, those with severe ARDS were weaned within eleven days versus five days for those without severe ARDS, p = 0.023. The overall mortality for critically ill patients was 22% versus 1% for those not critically ill. Furthermore, the 14-day mortality was 31% for patients with severe ARDS and 12% for patients without severe ARDS, p = 0.019. Patients with severe ARDS versus non-severe ARDS needed twice as long to wean off IMV (eleven versus five days) and had double the 14-day mortality of patients without severe ARDS.
Highlights
acute respiratory distress syndrome (ARDS) is a major outcome of COVID-19 patients that requires a remarkably long invasive mechanical ventilation (IMV)
We measured the outcomes of patients who were critically ill due to COVID-19 pneumonia; we examined the severity of ARDS and factors associated with (i) weaning patients off IMV and (ii) mortality in a city-wide study in Louisville, KY, USA
Our study demonstrated that 41.9% of patients with COVID-19 pneumonia developed
Summary
As of 22 June 2021, there have been 3,876,081 losses of human life reported worldwide due to the COVID-19 pandemic [1]. COVID-19 pneumonia resulting in critical illness is the main cause of the high death toll of this pandemic. COVID-19 have been reported to develop critical illness—primarily associated with acute respiratory distress syndrome (ARDS)—in a predominantly African American cohort [2]. The mortality rate of critically ill patients with COVID-19 has been reported at up to 98% [3]. The characteristics and major outcomes of critically ill patients due to COVID-19 pneumonia on a US city-wide scale have not yet been reported. ARDS is a major outcome of COVID-19 patients that requires a remarkably long invasive mechanical ventilation (IMV). The time to wean patients off IMV is a turning point in prognosis, at which point aggressive clinical management can be de-escalated
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