Recovery more likely in COVID-19 respiratory failure after ventilation, tracheostomy

Among hospitalized patients with respiratory failure, those with COVID-19 who required mechanical ventilation and tracheostomy were more likely to recover compared with those without COVID-19, according to data published in Chest.

“To our knowledge, our study is the first to report outcomes of patients with COVID-19 requiring mechanical ventilation beyond acute care hospitalization,” Tamas Dolinay, MD, PhD, a pulmonologist at the University of California, Los Angeles, and Barlow Respiratory Hospital, and colleagues wrote.

This retrospective cohort study evaluated 242 patients who were discharged from June 2020 to March 2021 from Barlow Respiratory Hospital, a long-term acute care facility, after receiving mechanical ventilation. Of these patients, 165 underwent tracheostomy and were considered for ventilator liberation; 128 did not have COVID-19-associated respiratory failure (mean age, 69.3 years; 62.5% men); and 37 had COVID-19 respiratory failure (mean age, 66.2 years; 78.4% men).

The primary outcome was ventilator liberation. Secondary outcomes included functional recovery, length of stay and discharge disposition. To assess functional ability, researchers analyzed the change in Functional Status Score for the ICU (FSS-ICU) between admission and hospital discharge.

According to study results, patients with COVID-19 had a higher adjusted rate of ventilator liberation compared with patients without COVID-19 when controlling for demographics, comorbidities, hemodialysis, vasopressor need, thrombocytopenia and length of stay (91.4% vs. 56%).

Researchers also observed a significantly higher mean change in FSS-ICU among patients with COVID-19 (9.49; 95% CI, 7.38-11.6) compared with patients without COVID-19 (2.08; 95% CI, 1.05-3.11).

The patients with COVID-19 had shorter adjusted lengths of stay compared with patients without COVID-19 (adjusted HR = 1.57; 95% CI, 1-2.46).

Researchers reported no significant differences between patients with and without COVID-19 related to hospital discharge location. However, patients with COVID-19 typically required a lower level of care.

“Our study provides new evidence that patients with COVID-19-associated respiratory failure requiring mechanical ventilation via tracheostomy have a better recovery potential than those without COVID-19, marked by improved ventilator liberation, better physical functioning and shorter [long-term acute care hospital] stay,” the researchers wrote.