TY - JOUR
AU - Krishnan, Jamuna K.
AU - Hoffman, Katherine L.
AU - Alshak, Mark N.
AU - Aronson, Kerri I.
AU - Ezeomah, Chiomah
AU - Hill, Shanna S.
AU - Martinez, Fernando J.
AU - Turetz, Meredith L.
AU - Well, Martin T.
AU - Schenck, Edward J.
AU - Rajan, Mangala
AU - Baer, Benjamin R
AU - Goyal, Parag
AU - Safford, Monika M.
PY - 2022
DA - April
TI - Assessing mortality differences across acute respiratory failure management strategies in Covid-19
JO - Journal of Critical Care
VL - 70
DO - https://doi.org/10.1016/j.jcrc.2022.154045
AB - PurposeProlonged observation could avoid invasive mechanical ventilation (IMV) and related risks in patients with Covid-19acute respiratory failure(ARF) compared to initiating early IMV. We aimed to determine the association between ARF management strategy and in-hospital mortality.Materials and methodsPatients 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. Coxproportional hazards regressionwas used to model in-hospital mortality and test an interaction between ARF management strategy and modified sequential organ failure assessment (mSOFA).ResultsAmong 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).ConclusionIn 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.
PB - Elsevier
UR - https://hdl.handle.net/10023/29586
KW - Coronavirus (COVID-19)
ER