Assessing mortality differences across acute respiratory failure management strategies in Covid-19

Authors: Krishnan, Jamuna K.;

Hoffman, Katherine L.;

Alshak, Mark N.;

Aronson, Kerri I.;

Ezeomah, Chiomah;

Hill, Shanna S.;

Martinez, Fernando J.;

Turetz, Meredith L.;

Well, Martin T.;

Schenck, Edward J.;

Rajan, Mangala;

Baer, Benjamin R;

Goyal, Parag;

Safford, Monika M.

Source: Journal of Critical Care

Full text

: https://doi.org/10.1016/j.jcrc.2022.154045

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.

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Cite as

Krishnan, J., Hoffman, K., Alshak, M., Aronson, K., Ezeomah, C., Hill, S., Martinez, F., Turetz, M., Well, M., Schenck, E., Rajan, M., Baer, B., Goyal, P. & Safford, M. 2022, 'Assessing mortality differences across acute respiratory failure management strategies in Covid-19', Journal of Critical Care, 70, article no: 154045. https://doi.org/10.1016/j.jcrc.2022.154045

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Identifiers

DOI: https://doi.org/10.1016/j.jcrc.2022.154045

Repository URI: https://hdl.handle.net/10023/29586