Clinical Characteristics of Initial Patients Successfully Extubated After Respiratory Failure Secondary to COVID-19 at Elmhurst Hospital Center (EHC)

RATIONALE COVID-19 infection has affected 5 million lives, resulting in over 300,000 deaths worldwide. Those with respiratory failure requiring mechanical ventilation (MV) make up less than 10% of individuals, but account for the majority of fatalities.(1) Exploring characteristics of those extubated, strategies for treatment and resource allocation can be potentially implemented. METHODS A retrospective review of the initial 33 adult patients positive for COVID19 admitted to EHC, with respiratory failure and extubated from 3/8/2020 to 5/8/2020 was performed. Clinical characteristics were evaluated descriptively. RESULTS Successfully extubated patients averaged 56 years of age, males made up 91% of the population. Average BMI was 28.2 and hemoglobin A1C was 6.26. The mean maximum creatinine was 4.39 and max procalcitonin was 26. Mean admission and maximum D-dimer levels were 5,349 and 12,450 respectively, while mean admission CRP was 204. The mean days on nasal cannula, non-rebreather and CPAP prior to intubation were 5, 4, and 3, respectively, with overall mean time to intubation of 11.9 days and average length of stay of 20.6 days. The mean minimum PaO2 was 57.7 (most often on 100% FiO2) and max mean PEEP was 12.7. Total sedation days and total pressors days were calculated giving each pressor or sedative used the equivalence of 1 to provide an estimate of sedative and pressor requirements. The mean number of pressor days was 9.8;with a mean number of sedative days as 28. Survival after extubation at time of analyses was (21/33) 63%. CONCLUSION These results signal that these initial extubated patients were quite hypoxic and ventilated with a low PEEP strategy deviating from those suggested by surviving sepsis guidelines. They were in a hyperinflammatory state with moderate renal failure and propensity for infection, however, perhaps the BMI, low A1C scores, relatively fast decline in D dimers and ventilation with low PEEP strategy allowed them to be mechanically liberated. Classifying patient demographics and disease severity early can help identify patients likely to achieve successful extubation. The duration of preintubation oxygen support, duration of intubation, ideal vent settings, and realistic sedative requirements should be explored to optimize successful MV and extubation strategies.