■本研究旨在调查2019年冠状病毒病危重老年患者有创机械通气(IMV)撤机失败的影响因素。
■我们招募了患有COVID-19的危重老年患者,这些患者在2022年12月至2023年6月期间入住医疗重症监护病房(ICU)并接受IMV。
■我们纳入了68例老年COVID-19危重患者(52例男性[76.5%]和16例女性[23.5%])。患者的中位年龄(四分位距)为75.5(70.3-82.8)岁。ICU住院时间中位数为11.5天(7.0~17.8天);34例(50.0%)成功脱离IMV。成功断奶组患有慢性阻塞性肺疾病的比例较高[6(17.6%)与0,P=0.033],糖尿病病例较少[7(20.6%)与16(47.1%),P=0.021]与断奶失败组比较。血清乳酸水平[1.5(1.2-2.3)与2.6(1.9-3.1)mmol/L,P<0.001],血尿素氮[8.2(6.3-14.4)vs.11.4(8.0-21.3)mmol/L,P=0.033],急性生理学和慢性健康评估(APACHE)II评分[19.0(12.0-23.3)与22.5(16.0-29.3),P=0.014],气管插管前住院天数[1.0(0.0-5.0)vs.3.0(0.0-11.0),P=0.023]断奶成功组明显下降,而PaO2/FiO2[148.3(94.6-200.3)vs.101.1(67.0-165.1),P=0.038]和血液淋巴细胞水平[0.6(0.4-1.0)vs.0.5(0.2-0.6)109/L,P=0.048]显著增加,与断奶失败组相比。多因素logistic回归分析显示糖尿病(OR=3.413,95CI1.029-11.326),P=0.045),APACHEII评分(OR=1.089,95%CI1.008-1.175),P=0.030),气管插管前住院天数(OR=1.137,95%CI1.023-1.264),P=0.017)是断奶失败的独立危险因素。
■在患有糖尿病的COVID-19的危重老年患者中,较高的APACHEII评分,气管插管前住院天数较长,从IMV断奶更具挑战性。这项研究可能有助于制定改善COVID-19治疗的策略。
UNASSIGNED: This study aimed to investigate the factors influencing weaning failure from invasive mechanical ventilation (IMV) in critically ill older patients with coronavirus disease 2019 (COVID-19).
UNASSIGNED: We enrolled critically ill older patients with COVID-19 who were admitted to the medical intensive care unit (ICU) and received IMV between December 2022 and June 2023.
UNASSIGNED: We included 68 critically ill older patients with COVID-19 (52 male [76.5 %] and 16 female individuals [23.5 %]). The patients\' median age (interquartile range) was 75.5 (70.3-82.8) years. The median length of ICU stay was 11.5 (7.0-17.8) days; 34 cases (50.0 %) were successfully weaned from IMV. The successfully weaned group had a higher proportion of underlying chronic obstructive pulmonary disease [6 (17.6 %) vs. 0, P = 0.033] and fewer cases of diabetes [7 (20.6 %) vs. 16 (47.1 %), P = 0.021] compared with the weaning failure group. Serum lactate levels [1.5 (1.2-2.3) vs. 2.6 (1.9-3.1) mmol/L, P < 0.001], blood urea nitrogen [8.2 (6.3-14.4) vs. 11.4 (8.0-21.3) mmol/L, P = 0.033], Acute Physiology and Chronic Health Evaluation (APACHE) II score [19.0 (12.0-23.3) vs. 22.5 (16.0-29.3), P = 0.014], and hospitalization days before endotracheal intubation [1.0 (0.0-5.0) vs. 3.0 (0.0-11.0), P = 0.023] were significantly decreased in the successfully weaned group, whereas PaO2/FiO2 [148.3 (94.6-200.3) vs. 101.1 (67.0-165.1), P = 0.038] and blood lymphocyte levels [0.6 (0.4-1.0) vs. 0.5 (0.2-0.6) 109/L, P = 0.048] were significantly increased, compared with the weaning failure group. Multivariate logistic regression analysis showed that diabetes (OR= 3.413, 95 %CI 1.029-11.326), P = 0.045), APACHE II Score (OR = 1.089, 95 % CI 1.008-1.175), P = 0.030), and hospitalization days before endotracheal intubation (OR = 1.137, 95 % CI 1.023-1.264), P = 0.017) were independent risk factors for weaning failure.
UNASSIGNED: In critically ill older patients with COVID-19 with diabetes, higher APACHE II Score, and longer hospitalization days before endotracheal intubation, weaning from IMV was more challenging. The study could help develop strategies for improving COVID-19 treatment.