Purpose: We sought to identify clinical factors that predict extubation failure (reintubation) and its prognostic implications in critically ill COVID-19 patients. Materials and Methods: Retrospective, multi-center cohort study of hospitalized COVID-19 patients. Multivariate competing risk models were employed to explore the rate of reintubation and its determining factors. Results: Two hundred eighty-one extubated patients were included (mean age, 61.0 years [±13.9]; 54.8% male). Reintubation occurred in 93 (33.1%). In multivariate analysis accounting for death, reintubation risk increased with age (hazard ratio [HR] 1.04 per 1-year increase, 95% confidence interval [CI] 1.02 -1.06), vasopressors (HR 1.84, 95% CI 1.04-3.60), renal replacement (HR 2.01, 95% CI 1.22-3.29), maximum PEEP (HR 1.07 per 1-unit increase, 95% CI 1.02 -1.12), paralytics (HR 1.48, 95% CI 1.08-2.25) and requiring more than nasal cannula immediately post-extubation (HR 2.19, 95% CI 1.37-3.50). Reintubation was associated with higher mortality (36.6% vs 2.1%; P < 0.0001) and risk of inpatient death after adjusting for multiple factors (HR 23.2, 95% CI 6.45-83.33). Prone ventilation, corticosteroids, anticoagulation, remdesivir and tocilizumab did not impact the risk of reintubation or death. Conclusions: Up to 1 in 3 critically ill COVID-19 patients required reintubation. Older age, paralytics, high PEEP, need for greater respiratory support following extubation and non-pulmonary organ failure predicted reintubation. Extubation failure strongly predicted adverse outcomes.
【저자키워드】 COVID-19, Critical illness, Novel coronavirus, reintubation, 【초록키워드】 Corticosteroids, Mortality, anticoagulation, Tocilizumab, prone, Ventilation, Remdesivir, extubation, risk, nasal, adverse outcomes, cohort study, Critically ill, male, Patient, Factors, death, age, prognostic, predict, COVID-19 patients, Analysis, Respiratory Support, COVID-19 patient, Organ failure, PEEP, Vasopressor, Factor, hospitalized COVID-19 patients, 95% CI, 95% confidence interval, hazard ratio, multivariate, material, renal, implication, Non-pulmonary, greater, predicted, identify, occurred, required, competing, clinical factor, 【제목키워드】 extubation, Impact, Factor, failure, Ill,