Respiratory support in COVID-19 patients in Kommunarka hospital: a single-centered, retrospective study

Abstract

Introduction. During the SARS-CoV-2 pandemic, worldwide healthcare system faced a new, insufficiently investigated, fast-spreading disease with multisystem failure and relatively high amount of severe diseased. Existing evidence base needs to be frequently revisited after data accumulation and analysis. Experience of dedicated COVID-19 centers should be summarized and implicated in clinical practice according to evidence-based principles, extensive clinical trial initiation. Objectives. To investigate baseline characteristics and treatment outcomes of patients with severe SARS-CoV-2 infection course, requiring respiratory support in the critical care settings of dedicated hospital. Materials and methods. In single-center retrospective study retrospective data collection of 451 respiratory support for COVID-19 related acute respiratory distress syndrome cases (noninvasive ventilation, mechanical ventilation) in intensive care unit patients for a 5-month period performed. The analysis aimed on demographic, clinical data, disease severity scores, respiratory support parameters and modality, continuous renal replacement therapy utilization and interleukin-6 receptor blockers administration, survival rates. Results. Respiratory support required 48.8 % of intensive care unit patients, the population was demographically balanced, Charlson Comorbidity Index was 4.46 ± 2.6 and was higher in the mechanically ventilated group. 30-day survival rate (all respiratory support cases) was 33.7 %, mortality structure analysis performed. The disease severity scores, respiratory mechanics among patients in dependence of respiratory support mode and during the period of case registration analysed as well. Median static respiratory compliance at the point of initiation of invasive mechanically ventilation was 43 (IQR 35–51). Mortality in the volume controlled mechanically ventilated group was higher. Conclusions. The patients, requiring respiratory support, during intensive care unit stay have high comorbidity levels. Indications for non-invasive ventilation may be extended on patients with lower Charlson index and initial SOFA score, however, early recognition of high risk of noninvasive ventilation failure required. Volume control invasive ventilation associated with higher mortality levels despite comparable disease severity scores. Further investigation required.