Among patients in the ICU who require mechanical ventilation and tracheostomy, those with COVID-19 have a higher chance for recovery than other patients. This was among the findings of research recently published in CHEST.
Investigators for the current study sought to determine potential reasons for successful ventilator liberation among patients admitted to long-term acute care hospitals with and without COVID-19-related respiratory failure. Toward that end, researchers conducted a retrospective cohort study of 165 patients discharged from 2020 to 2021 at Barlow Respiratory Hospital in Los Angeles. Of these patients, 37 were admitted for COVID-19.
The researchers found that the adjusted ventilatory liberation rate was higher among patients with COVID-19 compared with those without (91.4% vs 56%, respectively). Functional status was also higher in those with COVID-19. Furthermore, patients with COVID-19 had shorter lengths of stay, and a trend was observed reflecting lower levels of care for these patients.
The investigators hypothesized that increased rates of ventilator liberation in COVID patients is due to their enhanced recovery potential. COVID-19 patients spent more time at short-term acute care hospitals before transfer to long-term acute care hospitals (LTACH) and were already starting to recover. Of note, shock, thrombocytopenia, and hemodialysis did not vary among patients with and without COVID-19, although those with COVID-19 had more comorbidities.
“We believe that COVID patients represent a unique population in the post-acute care settings,” stated the study authors. “Allowing time for rehabilitation and ventilator liberation attempts can help them to achieve a recovery beyond what is seen in the general LTACH population.”
This study had various limitations. Patient selection could have eliminated candidates for ventilatory liberation. Furthermore, the investigators did not control for disease severity. Delays in tracheostomy may have changed the course of mechanical ventilation and played a role in lengthier durations of stay. Another limitation was the inability to assess long-term outcomes of patients beyond LTACH care.
This study provides new insights into the recovery of COVID patients and validates previous research indicating that patients on prolonged mechanical ventilation are a highly diverse population with discrepancies in recovery potential, said the investigators. The study also highlights the necessity of rehabilitation assessment and complex rehabilitation in the LTACH setting, said the researchers.
Dolinay T, Jun D, Chen L, Gornbein J. Mechanical ventilator liberation of COVID-19 patients in long-term acute care facility. Chest. Published online February 24, 2022. doi:10.1016/j.chest.2022.02.030