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Ventilator avoidance among critically ill COVID-19 patients with acute respiratory distress syndrome
OBJECTIVE: To determine the incidence and significance of ventilator avoidance in patients with critical coronavirus disease 2019 (COVID-19). METHODS: This prospective observational cohort study evaluated hospital mortality and 1-year functional outcome among critically ill patients with severe acut...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9634208/ https://www.ncbi.nlm.nih.gov/pubmed/36324277 http://dx.doi.org/10.1177/03000605221135446 |
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author | Fletcher, Jeffrey J Aughenbaugh, Arielle Svabek, Catherine Hahn, Peter Y Grifka, Ronald G |
author_facet | Fletcher, Jeffrey J Aughenbaugh, Arielle Svabek, Catherine Hahn, Peter Y Grifka, Ronald G |
author_sort | Fletcher, Jeffrey J |
collection | PubMed |
description | OBJECTIVE: To determine the incidence and significance of ventilator avoidance in patients with critical coronavirus disease 2019 (COVID-19). METHODS: This prospective observational cohort study evaluated hospital mortality and 1-year functional outcome among critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated acute respiratory distress syndrome (ARDS). The explanatory variable was ventilator avoidance, modeled as ‘initial refusal’ of intubation (yes/no). Modified Rankin Scale (mRS) scores were obtained from surviving patients (or their surrogates) via phone or email questionnaire. RESULTS: Among patients for whom intubation was recommended (n = 102), 40 (39%) initially refused (95% confidence interval [CI] 30%, 49%). The risk of death was 79.3% (49/62) in those who did not initially refuse intubation compared with 77.5% (31/40) in those who initially refused, with an adjusted odds ratio for death of 1.27 (95% CI 0.47, 3.48). The distribution of 1-year mRS scores was not significantly different between groups. CONCLUSION: Among critically ill patients with COVID-19-associated ARDS, ventilator avoidance was common, but was not associated with increased in-hospital mortality or 1-year functional outcome. |
format | Online Article Text |
id | pubmed-9634208 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-96342082022-11-05 Ventilator avoidance among critically ill COVID-19 patients with acute respiratory distress syndrome Fletcher, Jeffrey J Aughenbaugh, Arielle Svabek, Catherine Hahn, Peter Y Grifka, Ronald G J Int Med Res Prospective Clinical Research Report OBJECTIVE: To determine the incidence and significance of ventilator avoidance in patients with critical coronavirus disease 2019 (COVID-19). METHODS: This prospective observational cohort study evaluated hospital mortality and 1-year functional outcome among critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated acute respiratory distress syndrome (ARDS). The explanatory variable was ventilator avoidance, modeled as ‘initial refusal’ of intubation (yes/no). Modified Rankin Scale (mRS) scores were obtained from surviving patients (or their surrogates) via phone or email questionnaire. RESULTS: Among patients for whom intubation was recommended (n = 102), 40 (39%) initially refused (95% confidence interval [CI] 30%, 49%). The risk of death was 79.3% (49/62) in those who did not initially refuse intubation compared with 77.5% (31/40) in those who initially refused, with an adjusted odds ratio for death of 1.27 (95% CI 0.47, 3.48). The distribution of 1-year mRS scores was not significantly different between groups. CONCLUSION: Among critically ill patients with COVID-19-associated ARDS, ventilator avoidance was common, but was not associated with increased in-hospital mortality or 1-year functional outcome. SAGE Publications 2022-11-02 /pmc/articles/PMC9634208/ /pubmed/36324277 http://dx.doi.org/10.1177/03000605221135446 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial 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). |
spellingShingle | Prospective Clinical Research Report Fletcher, Jeffrey J Aughenbaugh, Arielle Svabek, Catherine Hahn, Peter Y Grifka, Ronald G Ventilator avoidance among critically ill COVID-19 patients with acute respiratory distress syndrome |
title | Ventilator avoidance among critically ill COVID-19 patients with
acute respiratory distress syndrome |
title_full | Ventilator avoidance among critically ill COVID-19 patients with
acute respiratory distress syndrome |
title_fullStr | Ventilator avoidance among critically ill COVID-19 patients with
acute respiratory distress syndrome |
title_full_unstemmed | Ventilator avoidance among critically ill COVID-19 patients with
acute respiratory distress syndrome |
title_short | Ventilator avoidance among critically ill COVID-19 patients with
acute respiratory distress syndrome |
title_sort | ventilator avoidance among critically ill covid-19 patients with
acute respiratory distress syndrome |
topic | Prospective Clinical Research Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9634208/ https://www.ncbi.nlm.nih.gov/pubmed/36324277 http://dx.doi.org/10.1177/03000605221135446 |
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