1. Ventilator avoidance among critically ill COVID-19 patients with acute respiratory distress syndrome.
- Author
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Fletcher JJ, Aughenbaugh A, Svabek C, Hahn PY, and Grifka RG
- Subjects
- Humans, SARS-CoV-2, Critical Illness, Prospective Studies, Ventilators, Mechanical, COVID-19, Respiratory Distress Syndrome therapy
- Abstract
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.
- Published
- 2022
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