Mechanical ventilation for COVID-19: Outcomes following discharge from inpatient treatment

• Published in: PloS one 2023-01, Vol.18 (1), p.e0277498
• Main Authors: Butler, Mark J, Best, Jennie H, Mohan, Shalini V, Jonas, Jennifer A, Arader, Lindsay, Yeh, Jackson
• Format: Article
• Language: English
• Subjects: Aftercare; Artificial respiration; Biology and life sciences; Blood pressure; Confounding (Statistics); Coronaviruses; COVID-19; COVID-19 - therapy; Creatinine; Cytokines; Dehydrogenases; Electronic health records; Electronic medical records; Female; Health hazards; Health services; Hospitalization; Humans; Illnesses; Infectious diseases; Inpatients; Laboratories; Length of stay; Male; Mechanical ventilation; Medical records; Medical research; Medicine and Health Sciences; Mortality; Oxygen saturation; Pandemics; Patient Discharge; Patient outcomes; Patient Readmission; Patients; Public health; Regression analysis; Regression models; Respiration, Artificial; Retrospective Studies; Statistical analysis; Variables; Ventilation; Ventilators; Viral diseases
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0277498

Though mechanical ventilation (MV) is used to treat patients with severe coronavirus disease 2019 (COVID-19), little is known about the long-term health implications of this treatment. Our objective was to determine the association between MV for treatment of COVID-19 and likelihood of hospital readmission, all-cause mortality, and reason for readmission. This study was a longitudinal observational design with electronic health record (EHR) data collected between 3/1/2020 and 1/31/2021. Participants included 17,652 patients hospitalized for COVID-19 during this period who were followed through 6/30/2021. The primary outcome was readmission to inpatient care following discharge. Secondary outcomes included all-cause mortality and reason for readmission. Rates of readmission and mortality were compared between ventilated and non-ventilated patients using Cox proportional hazards regression models. Differences in reasons for readmission by MV status were compared using multinomial logistic regression. Patient characteristics and measures of illness severity were balanced between those who were mechanically ventilated and those who were not utilizing 1-to-1 propensity score matching. The sample had a median age of 63 and was 47.1% female. There were 1,131 (6.4%) patients who required MV during their initial hospitalization. Rates (32.1% versus 9.9%) and hazard of readmission were greater for patients requiring MV in the propensity score-matched samples [hazard ratio (95% confidence interval) = 3.34 (2.72-4.10)]. Rates (15.3% versus 3.4%) and hazard [hazard ratio (95% confidence interval) = 3.12 (2.32-4.20)] of all-cause mortality were also associated with MV status. Ventilated patients were more likely to be readmitted for reasons which were classified as COVID-19, infectious diseases, and respiratory diagnoses compared to non-ventilated patients. Mechanical ventilation is a necessary treatment for severely ill patients. However, it may be associated with adverse outcomes including hospital readmission and death. More intense post-discharge monitoring may be warranted to decrease this associational finding.