Ventilator Weaning Outcomes in SARs-CoV-2 (+) Individuals in the LTACH Setting-A Retrospective Cohort Study

RESEARCH OBJECTIVES: To examine weaning outcomes of patients with a history of COVID-19 on prolonged mechanical ventilation (PMV) in the LTACH setting. DESIGN: Retrospective cohort. SETTING: A long-term acute care facility. PARTICIPANTS: Participants (N=25; mean±sd age, 58±13.2 yr) mostly consisted of overweight diabetic men with diaphragmatic dysfunction (DD) and no history of COPD or sleep apnea. INTERVENTIONS: Pulmonary function was determined using spirometry and arterial blood gas measurements. Diaphragmatic dysfunction was assessed using fluoroscopy; neuromuscular function measured via EMG. MAIN OUTCOME MEASURES: The primary outcome was weaned status at discharge. Weaning success was defined as MV liberation for over 48 hours at time of discharge. Variables included MIP, MEP, FVC, FEV1/FVC, DD (bilateral/unilateral/none) and PCO2. RESULTS: Most participants (57.7%) had either unilateral or bilateral diaphragmatic dysfunction. The proportion of participants with ventilator liberation success was 53.8% at time of discharge with a median [IQR] LOS of 41 [33-68] days. The mean (sd) FVC and PCO2 were 0.6 (±0.3)% and 51.4 (±9.7), respectively; the MEP and MIP were 43.9 (±16.7) and -36.5 (±15.9) cmH2O. Univariate logistic regression analyses found a significant association with MIP (OR 95% CI = (0.87-0.99); p-value = 0.0391) on wean status. CONCLUSIONS: Liberation from MV has been a challenge in the COVID-19 population with a large number of individuals subjected to PMV. Many studies have sought to examine the parameters for weaning in the ICU setting, but few have discussed weaning strategies in LTACHs. MIP may have the potential to help prognosticate weaning outcomes in the COVID-19 population. Further studies are needed to confirm and identify other parameters associated with successful weaning. AUTHOR(S) DISCLOSURES: The authors have no conflicts of interest.