Abstract
Purpose: This study aimed to describe the clinical and laboratory characteristics and the parameters of the respiratory mechanics of mechanically ventilated patients with confirmed COVID-19 pneumonia and to clarify the risk or protective factors for weaning failure.Methods: Patients diagnosed with COVID-19 pneumonia were selected from the special intensive care unit (ICU) of the Sino-French New City Branch of Tong Ji Hospital, Wuhan, and treated by the National Medical Team Work. They were divided into successful weaning (SW) group (N = 15) and unsuccessful weaning (USW) group (N = 18) according to the prognosis. Information of these patients was analyzed.Results: There were 33 patients included in this study. Patients in the USW group were associated with a poor outcome; the 28-day mortality rate was higher than in the SW group (86.7 vs. 16.7% p < 0.001). By comparison, we found that the initial plateau pressure (Pplat) and driving pressure (DP) of the USW group were higher and that compliance was lower than that of the SW group, but there was no difference between positive end-expiratory pressure (PEEP), partial pressure of carbon dioxide (PCO2), and the ratio of partial pressure arterial oxygen and fraction of inspired oxygen (P/F ratio). Comparing the worst respiratory mechanics parameters of the two groups, the results of the Pplat, DP, compliance, and PEEP were the same as the initial data. The PCO2 of the USW group was higher, while the P/F ratio was lower. A logistic regression analysis suggested that higher Pplat might be an independent risk factor and that higher compliance and lower DP might be protective factors for weaning failure of invasive mechanically ventilated patients with COVID-19 pneumonia.Conclusions: Patients with USW were associated with a poor outcome, higher Pplat might be a risk factor, and a higher compliance and a lower DP might be protective factors for the weaning failure of ventilated COVID-19 patients. Mechanical ventilation settings will affect the patient's prognosis.
Highlights
The outbreak of COVID-19 disease caused by the novel coronavirus (SARS-CoV-2) has been a worldwide pandemic problem and resulted in thousands of death [1]
By March 2020, 62 ventilated patients with confirmed COVID-19 pneumonia had been admitted to the special intensive care unit (ICU) of the SinoFrench New City Branch of Tong Ji Hospital, of whom 29 were excluded (11 died within 48 h of ICU admission, 17 with missed information, and one transferred to another center)
Patients in the unsuccessful weaning (USW) group were associated with a poor outcome, the 28-day mortality rate was higher than in the successful weaning (SW) group (86.7 vs. 16.7% p < 0.001), and ventilation-free day (VFD) of 28 days and ICU stays were lower than in the SW group (p = 0.022, 0.001)
Summary
The outbreak of COVID-19 disease caused by the novel coronavirus (SARS-CoV-2) has been a worldwide pandemic problem and resulted in thousands of death [1]. About 15–20% of suspected and confirmed patients developed dyspnea and severe hypoxemia [2]; since no specialized medication to treat SARS-CoV-2 infection has been identified at this time, mechanical ventilation is the main supportive treatment for critically ill patients, especially invasive mechanical ventilation. The mortality of ventilated patients with COVID-19 pneumonia was high (86.3% 19/22) in an observational study from a single center, the Jinyintan Hospital (a temporarily designated center for critically ill patients with COVID-19), Wuhan, China [3]. Recent studies showed that the DP was high, respiratory system compliance was low, and hypercapnia was common in the ventilated patients with COVID-19 while using low tidal volume ventilation [5, 6], but the sample size was small, and the risk factors for the weaning failure of the ventilated COVID-19 patients were not described
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