METHODS: Retrospective cross-sectional inpatient database.
METHODS: Eleven Midwest academic and community hospitals, United States.
METHODS: Adults, mechanically ventilated, from January 2020 to August 2022, who were subsequently readmitted within 6 months with a new diagnosis of LTS.
METHODS: None.
RESULTS: Six thousand eight hundred fifty-one COVID-19 negative and 1316 COVID-19 positive patients were intubated and had similar distribution by age (median 63.77 vs. 63.16 yr old), sex (male, 60.8%; n = 4173 vs. 60%; n = 789), endotracheal tube size (≥ 7.5, 75.8%; n = 5192 vs. 75.5%; n = 994), and comorbidities. The ICU length of stay (median [interquartile range (IQR)], 7.23 d [2.13-16.67 d] vs. 3.95 d [1.91-8.88 d]) and mechanical ventilation days (median [IQR], 5.57 d [1.01-14.18 d] vs. 1.37 d [0.35-4.72 d]) were longer in the COVID-19 positive group. The occurrence of LTS was double in the COVID-19 positive group (12.7%, n = 168 vs. 6.4%, n = 440; p < 0.001) and was most commonly diagnosed within 60 days of intubation. In multivariate analysis, the risk of LTS increased by 2% with each additional ICU day (hazard ratio [HR], 1.02; 95% CI, 1.02-1.03; p < 0.001), by 3% with each additional day of ventilation (HR, 1.03; 95% CI, 1.02-1.04; p < 0.001), and by 52% for each additional reintubation (HR, 1.52; 95% CI, 1.36-1.71; p < 0.001). We observed no significant association COVID-19 status and risk of LTS.
CONCLUSIONS: The occurrence of post-intubation LTS was double in a COVID-19 positive cohort, with higher risk with increasing number of days intubated, days in the ICU and especially with the number of reintubations. COVID-19 status was not an independent risk factor for LTS.
方法:回顾性横断面住院患者数据库。
方法:中西部11所学术和社区医院,美国。
方法:成人,机械通风,从2020年1月至2022年8月,他们随后在6个月内重新入院,新诊断为LTS。
方法:无。
结果:接受了680051例COVID-19阴性和1316例COVID-19阳性患者的插管,其年龄分布相似(中位数为63.77vs.63.16岁),性别(男性,60.8%;n=4173vs.60%;n=789),气管导管尺寸(≥7.5,75.8%;n=5192vs.75.5%;n=994),和合并症。ICU住院时间(中位数[四分位距(IQR)],7.23d[2.13-16.67d]vs.3.95d[1.91-8.88d])和机械通气天数(中位数[IQR],5.57d[1.01-14.18d]vs.COVID-19阳性组的1.37d[0.35-4.72d])更长。在COVID-19阳性组中,LTS的发生率是两倍(12.7%,n=168vs.6.4%,n=440;p<0.001),最常见于插管后60天内。在多变量分析中,ICU每增加一天,LTS的风险增加2%(危险比[HR],1.02;95%CI,1.02-1.03;p<0.001),每增加一天的通气次数为3%(HR,1.03;95%CI,1.02-1.04;p<0.001),每增加一次再插管的52%(HR,1.52;95%CI,1.36-1.71;p<0.001)。我们观察到COVID-19状态和LTS风险没有显著关联。
结论:在COVID-19阳性队列中,插管后LTS的发生率是两倍,随着插管天数的增加,风险更高,在ICU中的天数,尤其是重新插管的次数。COVID-19状态不是LTS的独立危险因素。