Complications of prolonged mechanical ventilation in patients with covid-19 infection

SESSION TITLE: Critical Care Posters 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Mechanical ventilation is often required in patients with respiratory failure caused by COVID-19. The appropriate time to tracheostomy tube placement for patients requiring mechanical ventilation remains unclear, and tracheostomy timing was variable during the COVID-19 pandemic. The aim of this study is to describe the complication rate resulting from prolonged mechanical ventilation in patients with COVID-19 respiratory failure, comparing those who underwent a tracheostomy with those who did not. METHODS: We conducted a retrospective review of all patients intubated due to COVID-19 respiratory failure at our tertiary medical center from March 1, 2020, to December 31, 2020. We excluded COVID-19-negative subjects and those intubated for other indications. We assessed demographics and patient outcomes from intubation to hospital discharge. The primary outcome was the mean time to complications, and secondary outcomes included the median time to extubation, tracheostomy, and discharge. RESULTS: Of the 146 included patients, 59% (86/146) were males, 75% were eventually extubated (111/146), 23% underwent tracheostomy (33/146), and 2% died while intubated (2/146). The median (IQR) age and BMI were 60 years (51-70) and 30.8 kg/m2 (27.3-36.7), respectively. The median (IQR) time to extubation or tracheostomy was 11 (7-16) and 26 (21-31) days. The complication rate was 50.4% (57/113) in the extubation group and 54.5% (18/33) in the tracheostomy group. The most common complications among the extubated were (total in percentage, [95%CI]) ventilator-associated pneumonia (VAP) (34.51%, [0.26-0.44]), reintubation for recurrent respiratory failure (10.62%, [0.06-0.18]), aspiration pneumonia/pneumonitis (4.42%, [0.02-0.10]), and posterior glottic stenosis (4.42%, [0.02-0.10]). Among the tracheostomy group, they were VAP (33.3%, [0.19-0.51]), accidental decannulation (21.21%, [0.10-0.39]), bleeding/hemoptysis (3.03%, [0.004-0.198]), and airway obstruction requiring bronchoscopy with therapeutic aspiration (3.03%, [0.004-0.198]). The median (IQR) time to discharge for the tracheostomy and extubated patients was 46 (36-58) and 23 (17-31) days, respectively. CONCLUSIONS: Prolonged mechanical ventilation for COVID-19 respiratory failure carries a high rate of complications, with VAP being the most common in our entire cohort. Patients with tracheostomy had a longer hospitalization than those who were extubated, though this could reflect differences in disease severity. Accidental decannulation was also high in our tracheostomy group. CLINICAL IMPLICATIONS: Our results emphasize the importance of early extubation measures to avoid complications. Studies are needed to investigate the potential association between obesity and suboptimal sedation in this population, especially in those who are at risk for VAP or self-decannulation. DISCLOSURES: No relevant relationships by Camilo Avendano No relevant relationships by Jason Beattie No relevant relationships by Juan Camilo Cedeno Serna No relevant relationships by Juan Lara Consultant relationship with Boston Scientific Please note: $1001 - $5000 by Adnan Majid, value=Consulting fee Consultant relationship with olympus Please note: $5001 - $20000 by Adnan Majid, value=Consulting fee Consultant relationship with pinacle biologics Please note: $1001 - $5000 by Adnan Majid, value=Consulting fee No relevant relationships by Mihir Parikh No relevant relationships by Raymond Parrish No relevant relationships by Brian Rosenberg No relevant relationships by Chenchen Zhang