Risk Factors and Outcomes Associated With Re-Intubation Secondary to Respiratory Failure in Patients With COVID-19 ARDS

• Published in: Respiratory care 2024-01, Vol.69 (1), p.50-60
• Main Authors: Halaseh, Ramez M, Drescher, Gail S, Al-Ahmad, Ma'amoon, Masri, Ihab H, Alayon, Amaris L, Ghawanmeh, Malik, Arar, Tareq, Mohammad, Saad Al-Deen, Pavate, Rea, Bakri, Mouaz Haj, Al-Tarbsheh, Ali, AlGhadir-AlKhalaileh, Mu'ed
• Format: Article
• Language: English
• Subjects: Acute respiratory distress syndrome; Care and treatment; Intubation; Original Research; Patient outcomes; Trachea
• ISSN: 0020-1324; 1943-3654; 1943-3654
• DOI: 10.4187/respcare.10881

COVID-19 is associated with variable symptoms and clinical sequelae. Studies have examined the clinical course of these patients, finding a prolonged need for invasive ventilation and variable re-intubation rates. However, no research has investigated factors and outcomes related to re-intubation secondary to respiratory failure among patients with COVID-19 with ARDS. We conducted a single-center, retrospective study on subjects intubated for ARDS secondary to COVID-19. The primary outcome was re-intubation status; secondary outcomes were hospital and ICU stay and mortality. Data were analyzed using between-group comparisons using chi-square testing for categorical information and Student test for quantitative data. Univariate and multivariate logistic regression was performed to determine factors related to re-intubation and mortality as dependent variables. One hundred and fourteen subjects were included, of which 32% required re-intubation. No between-group differences were detected for most demographic variables or comorbidities. No differences were detected in COVID-19 treatments, noninvasive respiratory support, mechanical circulatory support, or duration of ventilation. Midazolam (odds ratio [OR] 5.55 [95% CI 1.83-16.80] = .002), fentanyl (OR 3.64 [95% CI 1.26-10.52] = .02), and APACHE II scores (OR 1.08 [95% CI 1.030-1.147] = .005) were independently associated with re-intubation (area under the curve = 0.81). Re-intubated subjects had extended hospital (36.7 ± 22.7 d vs 26.1 ± 12.1 d = .01) and ICU (29.6 ± 22.4 d vs 15.8 ± 10.4 d < .001) stays. More subjects died who failed extubation (49% vs 3% < .001). Age (OR 1.07 [95% CI 1.02-1.23] = .005), male sex (OR 4.9 [95% CI 1.08-22.35] = .041), positive Confusion Assessment Method for the ICU (CAM-ICU) (OR 5.43 [95% CI 1.58-18.62] = .007), and re-intubation (OR 12.75 [95% CI 2.80-57.10] < .001) were independently associated with death (area under the curve = 0.93). Midazolam, fentanyl, and higher APACHE II scores were independently associated with re-intubation secondary to respiratory failure in subjects with COVID-19-related ARDS. Furthermore, age, male sex, positive CAM-ICU, and re-intubation were independently associated with mortality. Re-intubation also correlated with prolonged hospital and ICU stay.