Outcomes Among Mechanically Ventilated Patients With Severe Pneumonia and Acute Hypoxemic Respiratory Failure From SARS-CoV-2 and Other Etiologies

• Published in: JAMA network open 2023-01, Vol.6 (1), p.e2250401-e2250401
• Main Authors: Nolley, Eric P, Sahetya, Sarina K, Hochberg, Chad H, Hossen, Shakir, Hager, David N, Brower, Roy G, Stuart, Elizabeth A, Checkley, William
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Coronaviruses; COVID-19; COVID-19 - complications; Female; Humans; Male; Middle Aged; Mortality; Pneumonia; Respiration, Artificial; Respiratory failure; Respiratory Insufficiency - epidemiology; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; Respiratory system; Retrospective Studies; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2022.50401

Early observations suggested that COVID-19 pneumonia had a higher mortality rate than other causes of pneumonia. To compare outcomes between mechanically ventilated patients with pneumonia due to COVID-19 (March 2020 to June 2021) and other etiologies (July 2016 to December 2019). This retrospective cohort study was conducted at the Johns Hopkins Healthcare System among adult patients (aged ≥18 years) with pneumonia who required mechanical ventilation in the first 2 weeks of hospitalization. Clinical, laboratory, and mechanical ventilation data were extracted from admission to hospital discharge or death. Pneumonia due to COVID-19. The primary outcome was 90-day in-hospital mortality. Secondary outcomes were time to liberation from mechanical ventilation, hospital length of stay, static respiratory system compliance, and ventilatory ratio. Unadjusted and multivariable-adjusted logistic regression, proportional hazards regression, and doubly robust regression were used in propensity score-matched sets to compare clinical outcomes. Overall, 719 patients (mean [SD] age, 61.8 [15.3] years; 442 [61.5%] were male; 460 [64.0%] belonged to a minoritized racial group and 253 [35.2%] were White) with severe COVID-19 pneumonia and 1127 patients (mean [SD] age, 60.9 [15.8] years; 586 [52.0%] were male; 459 [40.7%] belonged to a minoritized racial group and 655 [58.1%] were White) with severe non-COVID-19 pneumonia. In unadjusted analyses, patients with COVID-19 pneumonia had higher 90-day mortality (odds ratio, 1.21, 95% CI 1.04-1.41), longer time on mechanical ventilation (subdistribution hazard ratio 0.72, 95% CI 0.63-0.81), and lower compliance (32.0 vs 28.4 mL/kg PBW/cm H2O; P