Extubation Failure in Critically Ill COVID-19 Patients: Risk Factors and Impact on In-Hospital Mortality

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dc.citation.firstpage1018
dc.citation.issueNumber9
dc.citation.journalTitleJournal of Intensive Care Medicine
dc.citation.lastpage1024
dc.citation.volumeNumber36
dc.contributor.authorIonescu, Filip
dc.contributor.authorZimmer, Markie S.
dc.contributor.authorPetrescu, Ioana
dc.contributor.authorCastillo, Edward
dc.contributor.authorBozyk, Paul
dc.contributor.authorAbbas, Amr
dc.contributor.authorAbplanalp, Lauren
dc.contributor.authorDogra, Sanjay
dc.contributor.authorNair, Girish B.
dc.date.accessioned2021-08-20T20:24:22Z
dc.date.available2021-08-20T20:24:22Z
dc.date.issued2021
dc.description.abstractPurpose:We sought to identify clinical factors that predict extubation failure (reintubation) and its prognostic implications in critically ill COVID-19 patients.Materials and Methods:Retrospective, multi-center cohort study of hospitalized COVID-19 patients. Multivariate competing risk models were employed to explore the rate of reintubation and its determining factors.Results:Two hundred eighty-one extubated patients were included (mean age, 61.0 years [±13.9]; 54.8% male). Reintubation occurred in 93 (33.1%). In multivariate analysis accounting for death, reintubation risk increased with age (hazard ratio [HR] 1.04 per 1-year increase, 95% confidence interval [CI] 1.02 -1.06), vasopressors (HR 1.84, 95% CI 1.04-3.60), renal replacement (HR 2.01, 95% CI 1.22-3.29), maximum PEEP (HR 1.07 per 1-unit increase, 95% CI 1.02 -1.12), paralytics (HR 1.48, 95% CI 1.08-2.25) and requiring more than nasal cannula immediately post-extubation (HR 2.19, 95% CI 1.37-3.50). Reintubation was associated with higher mortality (36.6% vs 2.1%; P < 0.0001) and risk of inpatient death after adjusting for multiple factors (HR 23.2, 95% CI 6.45-83.33). Prone ventilation, corticosteroids, anticoagulation, remdesivir and tocilizumab did not impact the risk of reintubation or death.Conclusions:Up to 1 in 3 critically ill COVID-19 patients required reintubation. Older age, paralytics, high PEEP, need for greater respiratory support following extubation and non-pulmonary organ failure predicted reintubation. Extubation failure strongly predicted adverse outcomes.
dc.identifier.citationIonescu, Filip, Zimmer, Markie S., Petrescu, Ioana, et al.. "Extubation Failure in Critically Ill COVID-19 Patients: Risk Factors and Impact on In-Hospital Mortality." <i>Journal of Intensive Care Medicine,</i> 36, no. 9 (2021) Sage: 1018-1024. https://doi.org/10.1177/08850666211020281.
dc.identifier.digital8.85E+15
dc.identifier.doihttps://doi.org/10.1177/08850666211020281
dc.identifier.urihttps://hdl.handle.net/1911/111304
dc.language.isoeng
dc.publisherSage
dc.rightsThis article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.titleExtubation Failure in Critically Ill COVID-19 Patients: Risk Factors and Impact on In-Hospital Mortality
dc.typeJournal article
dc.type.dcmiText
dc.type.publicationpublisher version
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