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

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.digital08850666211020281
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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