Weaning Outcomes and Clinical Characteristics of Severe Mechanically Ventilated COVID-19 Patients During the Three Waves of the COVID-19 Pandemic in Israel

Abstract

Background: Most of severe COVID-19 patients who survive the intensive care remain mechanically ventilated and require weaning and further rehabilitation. Objectives: This study compares the characteristics and outcomes of severe mechanically ventilated COVID-19 patients admitted to a weaning facility. In addition, the study describes patterns of weaning experienced during the three waves of COVID-19 in Israel. Methods: Clinical, demographic and outcome data was gathered retrospectively for 70 severe mechanically ventilated patients. Univariate analysis was performed to explain the variability in outcome variables. Results: Weaning success was 94% with mean weaning duration of 13±17 days. None of the demographic and clinical variables examined influenced the weaning duration, however patients with morbid obesity and/or diabetes were found to have shorter total duration on mechanical ventilation, hereby suggesting the presence of an obesity paradox. Extra corporal membrane oxygenation (ECMO) was used in 29% of the patients, and didn’t influence the weaning duration in spite being associated with higher rate of pleural complication. There were three main weaning patterns seen in different overlapping levels in the cohort patients: low capacity extra pulmonary pattern, fibrotic-bullosic pulmonary injury pattern and nonspecific interstitial pneumonitis pattern. Conclusions: The current study shows a high success rate of weaning, independent on comorbidities and previous ECMO use.