Background
Mortality due to COVID-19 is high, especially in patients
requiring mechanical ventilation. The purpose of the study is to investigate
associations between mortality and variables measured during the first three
days of mechanical ventilation in patients with COVID-19 intubated at ICU
admission.
Methods
Multicenter, observational, cohort study includes
consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February
25 and July 31, 2020, who required intubation at ICU admission and mechanical
ventilation for more than three days. We collected demographic and clinical
data prior to admission; information about clinical evolution at days 1 and 3
of mechanical ventilation; and outcomes.
Results
Of the 2,095 patients with COVID-19 admitted to the ICU,
1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation
at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6
[80.0–171.2] to 180.0 [135.4–227.9] mmHg and the ventilatory ratio from 1.73
[1.33–2.25] to 1.96 [1.61–2.40]. In-hospital mortality was 38.7%. A higher
increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI
1.01–1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01–1.09], p = 0.005)
and a lower increase in platelet counts (OR 0.96 [CI 0.93–1.00], p = 0.037)
were independently associated with a higher risk of death. No association
between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI
0.95 to 1.02], p = 0.47).
Conclusions
Higher ventilatory ratio and its increase at day 3 is
associated with mortality in patients with COVID-19 receiving mechanical
ventilation at ICU admission. No association was found in the PaO2/FiO2 variation.
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