Timing and Predictors of Decannulation: Comparison Between COVID-19 and NO-COVID-19 Ards

Abstract

<b>Background:</b> Tracheotomy is a routine procedure for patients requiring prolonged mechanical ventilation (MV) in intensive care units (ICUs), included Covid-19 ARDS, for which few data about decannulation are available. <b>Aim:</b> To compare time to decannulation between Covid-19 and no-Covid-19 ARDS and identify possible predictive factors. <b>Methods:</b> In this retrospective, multicenter study, 96 tracheotomized patients, admitted from March 2020 to May 2021 in 5 pulmonary wards after an ICU stay due to Covid-19 ARDS, are compared to 32 tracheotomized ARDS patients not associated to Covid-19 admitted before its outbreak. Clinical, demographic data and comorbidities are analyzed. <b>Results:</b> Median age is lower in Covid-19 group; sex prevalence, body mass index (BMI) and frailty do not differ between the two groups as well as timing of decannulation (median days: 14 [IQR 9-22] vs 13 [IQR 8-18] in no-Covid-19 and Covid-19 ARDS, respectively; p=0.08). In a multivariate linear regression analysis, Medical Research Council (MRC) scale (β -0.33; p&lt;0.0001), duration of steroids (β 0.28; p=0.001), clinical complications (β 0.27; p=0.004), PaO2/FiO2 ratio (β -0.25; p=0.007) and history of smoke (β 0.18; p=0.04) significantly predict timing of decannulation in both groups. <b>Conclusions:</b> Timing of decannulation in Covid-19 ARDS patients is not different from no-Covid-19 ARDS. In Covid-19 patients, past knowledge about decannulation and the need of relieve post-ICU setting avoid the delay in decannulation time if compared to no-Covid-19 patients. ICU-acquired weakness, evaluated by MRC scale, seems to be a strong predictor of longer time to decannulation in the two groups.