Assessment of respiratory support decision and the outcome of invasive mechanical ventilation in severe COVID-19 with ARDS  

作　　者：Shuhan Cai Fangfang Zhu Hongtao Hu Hui Xiang Dawei Wang Jing Wang Lu Li Xiao Yang Aihua Qin Xin Rao Yun Luo Jianguo Li Kianoush B.Kashani Bo Hu Zhiyong Peng 

机构地区：[1]Department of Critical Care Medicine,Zhongnan Hospital of Wuhan University,Wuhan,Hubei 430071,China [2]Clinical Research Center of Hubei Critical Care Medicine,Wuhan,Hubei 430071,China [3]Division of Nephrology and Hypertension,Division of Pulmonary and Critical Care Medicine,Department of Medicine,Mayo Clinic,Rochester,MN 55905,USA [4]Division of Pulmonary and Critical Care Medicine,Department of Medicine,Mayo Clinic,Rochester,MN 55905,USA

出　　处：《Journal of Intensive Medicine》2022年第2期92-102,共11页重症医学（英文）

基　　金：supported by the Chinese Medical Information and Big Data Association(Bo Hu,No.Z-2019-1-003);the Translational Medicine and Interdisciplinary Research Joint Fund of Zhongnan Hospital of Wuhan University(Bo Hu,No.ZNJC202011);the key project of the Ministry of Science and Technology of China(Zhiyong Peng,No.2020YFC0841300).

摘　　要：Background:The coronavirus disease 2019(COVID-19)is an ongoing pandemic.Invasive mechanical ventilation(IMV)is essential for the management of COVID-19 with acute respiratory distress syndrome(ARDS).We aimed to assess the impact of compliance with a respiratory decision support system on the outcomes of patients with COVID-19-associated ARDS who required IMV.Methods:In this retrospective,single-center,case series study,patients with COVID-19-associated ARDS who required IMV at Zhongnan Hospital of Wuhan University,China,from January 8th,2020,to March 24th,2020,with the final follow-up date of April 20th,2020,were included.Demographic,clinical,laboratory,imaging,and management information were collected and analyzed.Compliance with the respiratory support decision system was documented,and its relationship with 28-day mortality was evaluated.Results:The study included 46 COVID-19-associated ARDS patients who required IMV.The median age of the 46 patients was 68.5 years,and 31 were men.The partial pressure of arterial oxygen(PaO_(2))/fraction of inspired oxygen(FiO_(2))ratio at intensive care unit(ICU)admission was 104 mmHg.The median total length of IMV was 12.0(interquartile range[IQR]:6.0–27.3)days,and the median respiratory support decision score was 11.0(IQR:7.8–16.0).To 28 days after ICU admission,18(39.1%)patients died.Survivors had a significantly higher respiratory support decision score than non-survivors(15.0[10.3–17.0]vs.8.5(6.0–10.3),P=0.001).Using receiver operating characteristic(ROC)curve to assess the discrimination of respiratory support decision score to 28-day mortality,the area under the curve(AUC)was 0.796(95%confidence interval[CI]:0.657–0.934,P=0.001)and the cut-offwas 11.5(sensitivity=0.679,specificity=0.889).Patients with a higher score(>11.5)were more likely to survive at 28 days after ICU admission(log-rank test,P<0.001).Conclusions:For severe COVID-19-associated ARDS with IMV,following the respiratory support decision and assessing completion would improve the progress of vent

关 键 词：COVID-19 Acute respiratory distress syndrome(ARDS) Respiratory support decision Invasive mechanical ventilation Severe acute respiratory coronavirus 2 (SARS-CoV-2) 

分 类 号：R56[医药卫生—呼吸系统]