Long-Term Acute Care Hospital Outcomes of Mechanically Ventilated and Non-Ventilated Patients with COVID-19

Abstract

Background: Patients with coronavirus disease 2019 (COVID-19) and respiratory failure requiring invasive or non-invasive ventilation in acute care hospitals are commonly transferred to long-term acute care hospitals (LTACHs). Data on the clinical characteristics and outcomes of these patients is lacking. Objectives: To describe for the first-time clinical characteristics and outcomes of a cohort of patients with COVID-19 and respiratory failure requiring invasive or non-invasive mechanical ventilation transferred to two Chicago-area LTACHs. Methods: From April 17, 2020 to June 30, 2020, fifteen COVID-19 patients who had been liberated from mechanical ventilation at the acute care hospital were transferred to the LTACHs. These patients were matched with 14 COVID-19 patients transferred to the same LTACHs for weaning from prolonged invasive ventilation. Demographic, clinical, and laboratory data were collected and analyzed. Final date of follow-up was December 20, 2020. Results: The median (interquartile range) age of non-mechanically ventilated (non-MV) patients at LTACH admission was 63.0 years (55.0-74.0);7 (46.7%) patients were women and 8 (53.3%) resided in low-income areas. The corresponding values in patients mechanically ventilated (MV) at LTACH admission were 64.0 years (58.0-73.3), 6 (42.9%) women and 8 (57.1%) resided in low-income areas. Race distribution, premorbid functional status (Zubrod score), premorbid clinical characteristics (Charlson Comorbidity Index), and severity of disease at LTACH admission (APACHE II) were equivalent in the two groups of patients. The most common indications for LTACH transfer in the non-MV group were tracheostomy decannulation (60.0%), weaning from high-flow oxygen (40%) and delirium/encephalopathy (33.3%). The corresponding indications in the MV group were weaning from invasive ventilation (100%), prolonged antibiotic therapy (42.9%) and delirium/encephalopathy (14.3%). No patient in the non-MV group required mechanical ventilation during LTACH stay, 7 of 9 (77.8%) with a tracheostomy were decannulated and 1 (6.7%) died. In the MV group, 13 (92.9%) were successfully weaned, and 6 (42.9%) were decannulated and none died. Five (33.3%) patients in the non-MV group and 2 (15.4%, p=0.396) in the MV group were discharged home. The remaining were transferred to a rehabilitation facility, nursing home or acute care hospital. One patient in the MV group remains in the LTACH. Conclusion: Irrespective of mechanical ventilation status at LTACH admission, most COVID-19 patients survived LTACH admission, yet the majority were not discharged home but required ongoing inpatient medical care.