Journal Article

P213 Factors influencing outcome in COVID-19 patients requiring respiratory support – A single centre experience from West Midlands

Razak, A, Irshad, S, Puntan, D, Butt, S, Nathani, N, Ansari, Z

2021

Overview

IntroductionRespiratory failure in COVID pneumonia is often associated with ARDS. Invasive mechanical ventilation (IMV) is associated with high mortality and prolonged hospital stay. Continuous positive airways pressure (CPAP) has emerged as a bridge to IMV or as ceiling of care in patients with high clinical frailty scale (CFS).MethodsWe retrospectively analysed data of patients admitted our respiratory support unit (RSU) between September 2020 till January 2021. Patients admitted to our RSU received CPAP, High flow nasal oxygen( HFNO) and non invasive ventilation (NIV).Results118 patients were included in the analysis. Mean age was 71 years with 61% (n = 72) comprising of male patients. 77 patients (65%) patients receiving respiratory support (RS) died. 80(67%) patients had more 2 or more co morbidities. 60%(n=71) and 20.3% (n =24) received CPAP and HFNO as predominant modality respectively. Mean CFS was 4.3 in survival group as compared to 4.7 in survival group (p 1.98).88% patients (n=67) who died were aged above 65. Average time on RS was 7.5 days and length of stay (LOS) was 12.5 days. RS compliance was higher in survival group 85%(n=35) as compared to deceased group 42%(n=32). Time on RS in survival and deceased group were comparable 7.2 days and 8.4 days respectively (p 1.98). Time from positive PCR test to start of RS was lower in survival group (2.9 days vs 2 days, p 0.18). Mean D Dimers were 1.7 in survival group as compared to deceased group 3.5 (p 0.18). Use of syringe driver was high in deceased group (66% n=51) as compared to survival group (n=2). Mean BMI was higher in survival group (33.9 vs 28.7, p 0.001).Abstract P213 Table 1 CPAP survived CPAP Deceased P value Age 62 77 0.000004* BMI 33 28.7 0.001* CFS 4.3 4.7 1.98 CRP 89 136 0.004* D Dimer 1.7 3.6 0.18 Troponin 325 125 0.19 Time to start RS (days) 2 2.9 0.10 Length of stay(days) 13.4 12.1 0.42 Days on RS (days) 8.4 7.2 1.98 *p < 0.05 = statistically significantDiscussionAge, high CFS, and poor compliance with CPAP is associated with higher mortality in COVID 19 related ARDS. Further studies are needed to assess impact of troponin and D Dimer on COVID related ARDS outcomes.

• Publisher: BMJ Publishing Group Ltd and British Thoracic Society,BMJ Publishing Group LTD
• Subject: Length of stay / Oxygen, CPAP, NIV or ICU: what works in COVID-19? / Respiratory failure / Ventilation