Assessing mortality differences across acute respiratory failure management strategies in Covid-19
Abstract
Purpose Prolonged observation could avoid invasive mechanical ventilation (IMV) and related risks in patients with Covid-19 acute respiratory failure (ARF) compared to initiating early IMV. We aimed to determine the association between ARF management strategy and in-hospital mortality. Materials and methods Patients in the Weill Cornell Covid-19 registry who developed ARF between March 5 – March 25, 2020 were exposed to an early IMV strategy; between March 26 – April 1, 2020 to an intermediate strategy; and after April 2 to prolonged observation. Cox proportional hazards regression was used to model in-hospital mortality and test an interaction between ARF management strategy and modified sequential organ failure assessment (mSOFA). Results Among 632 patients with ARF, 24% of patients in the early IMV strategy died versus 28% in prolonged observation. At lower mSOFA, prolonged observation was associated with lower mortality compared to early IMV (at mSOFA = 0, HR 0.16 [95% CI 0.04–0.57]). Mortality risk increased in the prolonged observation strategy group with each point increase in mSOFA score (HR 1.29 [95% CI 1.10–1.51], p = 0.002). Conclusion In Covid-19 ARF, prolonged observation was associated with a mortality benefit at lower mSOFA scores, and increased mortality at higher mSOFA scores compared to early IMV.
Citation
Krishnan , J K , Rajan , M , Baer , B R , Hoffman , K L , Alshak , M N , Aronson , K I , Goyal , P , Ezeomah , C , Hill , S S , Martinez , F J , Turetz , M L , Well , M T , Safford , M M & Schenck , E J 2022 , ' Assessing mortality differences across acute respiratory failure management strategies in Covid-19 ' , Journal of Critical Care , vol. 70 , 154045 . https://doi.org/10.1016/j.jcrc.2022.154045
Publication
Journal of Critical Care
Status
Peer reviewed
Type
Journal article
Description
Funding: Dr. Krishnan reports support from NIH T32 HL134629. Dr. Schenck reports support from NHLBI K23 HL151876.Collections
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