医学
2019年冠状病毒病(COVID-19)
急性呼吸窘迫
2019-20冠状病毒爆发
严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)
重症监护医学
急性呼吸窘迫综合征
医疗急救
急诊医学
肺
病毒学
内科学
疾病
爆发
传染病(医学专业)
作者
Vikram B. Gondhalekar,Amir H. Gandomi,Stephen E. Gilman,Negin Hajizadeh,Zubair Hasan,Matthew Bank,Daniel M. Rolston,Allison Cohen,Timmy Li,Mitsuaki Nishikimi,Mangala Narasimhan,Lance B. Becker,Daniel Jafari
标识
DOI:10.1097/ccm.0000000000006252
摘要
Nonconventional ventilators (NCVs), defined here as transport ventilators and certain noninvasive positive pressure devices, were used extensively as crisis-time ventilators for intubated patients with COVID-19. We assessed whether there was an association between the use of NCV and higher mortality, independent of other factors.This is a multicenter retrospective observational study.The sample was recruited from a single healthcare system in New York. The recruitment period spanned from March 1, 2020, to April 30, 2020.The sample includes patients who were intubated for COVID-19 acute respiratory distress syndrome (ARDS).None.The primary outcome was 28-day in-hospital mortality. Multivariable logistic regression was used to derive the odds of mortality among patients managed exclusively with NCV throughout their ventilation period compared with the remainder of the sample while adjusting for other factors. A secondary analysis was also done, in which the mortality of a subset of the sample exclusively ventilated with NCV was compared with that of a propensity score-matched subset of the control group. Exclusive use of NCV was associated with a higher 28-day in-hospital mortality while adjusting for confounders in the regression analysis (odds ratio, 1.41; 95% CI [1.07-1.86]). In the propensity score matching analysis, the mortality of patients exclusively ventilated with NCV was 68.9%, and that of the control was 60.7% (p = 0.02).Use of NCV was associated with increased mortality among patients with COVID-19 ARDS. More lives may be saved during future ventilator shortages if more full-feature ICU ventilators, rather than NCVs, are reserved in national and local stockpiles.
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