Filip Ionescu1, Markie S Zimmer1, Ioana Petrescu1, Edward Castillo2,3, Paul Bozyk4, Amr Abbas5, Lauren Abplanalp4, Sanjay Dogra4, Girish B Nair4. 1. Department of Internal Medicine, 21818Beaumont Health System, OUWB School of Medicine, Royal Oak, MI, USA. 2. Department of Radiation Oncology, 21818Beaumont Health System, OUWB School of Medicine, Royal Oak, MI, USA. 3. Department of Computational and Applied Mathematics, Rice University, TX, USA. 4. Division of Pulmonary and Critical Care Medicine, 21818Beaumont Health System, OUWB School of Medicine, Royal Oak, MI, USA. 5. Department of Cardiovascular Medicine, 21818Beaumont Health System, Royal Oak, OUWB School of Medicine, MI, USA.
Abstract
PURPOSE: We sought to identify clinical factors that predict extubation failure (reintubation) and its prognostic implications in critically ill COVID-19 patients. MATERIALS AND METHODS: Retrospective, multi-center cohort study of hospitalized COVID-19 patients. Multivariate competing risk models were employed to explore the rate of reintubation and its determining factors. RESULTS: Two hundred eighty-one extubated patients were included (mean age, 61.0 years [±13.9]; 54.8% male). Reintubation occurred in 93 (33.1%). In multivariate analysis accounting for death, reintubation risk increased with age (hazard ratio [HR] 1.04 per 1-year increase, 95% confidence interval [CI] 1.02 -1.06), vasopressors (HR 1.84, 95% CI 1.04-3.60), renal replacement (HR 2.01, 95% CI 1.22-3.29), maximum PEEP (HR 1.07 per 1-unit increase, 95% CI 1.02 -1.12), paralytics (HR 1.48, 95% CI 1.08-2.25) and requiring more than nasal cannula immediately post-extubation (HR 2.19, 95% CI 1.37-3.50). Reintubation was associated with higher mortality (36.6% vs 2.1%; P < 0.0001) and risk of inpatient death after adjusting for multiple factors (HR 23.2, 95% CI 6.45-83.33). Prone ventilation, corticosteroids, anticoagulation, remdesivir and tocilizumab did not impact the risk of reintubation or death. CONCLUSIONS: Up to 1 in 3 critically ill COVID-19 patients required reintubation. Older age, paralytics, high PEEP, need for greater respiratory support following extubation and non-pulmonary organ failure predicted reintubation. Extubation failure strongly predicted adverse outcomes.
PURPOSE: We sought to identify clinical factors that predict extubation failure (reintubation) and its prognostic implications in critically ill COVID-19 patients. MATERIALS AND METHODS: Retrospective, multi-center cohort study of hospitalized COVID-19 patients. Multivariate competing risk models were employed to explore the rate of reintubation and its determining factors. RESULTS: Two hundred eighty-one extubated patients were included (mean age, 61.0 years [±13.9]; 54.8% male). Reintubation occurred in 93 (33.1%). In multivariate analysis accounting for death, reintubation risk increased with age (hazard ratio [HR] 1.04 per 1-year increase, 95% confidence interval [CI] 1.02 -1.06), vasopressors (HR 1.84, 95% CI 1.04-3.60), renal replacement (HR 2.01, 95% CI 1.22-3.29), maximum PEEP (HR 1.07 per 1-unit increase, 95% CI 1.02 -1.12), paralytics (HR 1.48, 95% CI 1.08-2.25) and requiring more than nasal cannula immediately post-extubation (HR 2.19, 95% CI 1.37-3.50). Reintubation was associated with higher mortality (36.6% vs 2.1%; P < 0.0001) and risk of inpatient death after adjusting for multiple factors (HR 23.2, 95% CI 6.45-83.33). Prone ventilation, corticosteroids, anticoagulation, remdesivir and tocilizumab did not impact the risk of reintubation or death. CONCLUSIONS: Up to 1 in 3 critically ill COVID-19 patients required reintubation. Older age, paralytics, high PEEP, need for greater respiratory support following extubation and non-pulmonary organ failure predicted reintubation. Extubation failure strongly predicted adverse outcomes.
Authors: Lucas M Fleuren; Tariq A Dam; Michele Tonutti; Daan P de Bruin; Robbert C A Lalisang; Diederik Gommers; Olaf L Cremer; Rob J Bosman; Sander Rigter; Evert-Jan Wils; Tim Frenzel; Dave A Dongelmans; Remko de Jong; Marco Peters; Marlijn J A Kamps; Dharmanand Ramnarain; Ralph Nowitzky; Fleur G C A Nooteboom; Wouter de Ruijter; Louise C Urlings-Strop; Ellen G M Smit; D Jannet Mehagnoul-Schipper; Tom Dormans; Cornelis P C de Jager; Stefaan H A Hendriks; Sefanja Achterberg; Evelien Oostdijk; Auke C Reidinga; Barbara Festen-Spanjer; Gert B Brunnekreef; Alexander D Cornet; Walter van den Tempel; Age D Boelens; Peter Koetsier; Judith Lens; Harald J Faber; A Karakus; Robert Entjes; Paul de Jong; Thijs C D Rettig; Sesmu Arbous; Sebastiaan J J Vonk; Mattia Fornasa; Tomas Machado; Taco Houwert; Hidde Hovenkamp; Roberto Noorduijn Londono; Davide Quintarelli; Martijn G Scholtemeijer; Aletta A de Beer; Giovanni Cinà; Adam Kantorik; Tom de Ruijter; Willem E Herter; Martijn Beudel; Armand R J Girbes; Mark Hoogendoorn; Patrick J Thoral; Paul W G Elbers Journal: Crit Care Date: 2021-12-27 Impact factor: 9.097
Authors: Wanjun Liu; Gan Tao; Yijun Zhang; Wenyan Xiao; Jin Zhang; Yu Liu; Zongqing Lu; Tianfeng Hua; Min Yang Journal: Front Med (Lausanne) Date: 2022-01-18