Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2021; 9(31): 9481-9490
Published online Nov 6, 2021. doi: 10.12998/wjcc.v9.i31.9481
Retrospective analysis of influencing factors on the efficacy of mechanical ventilation in severe and critical COVID-19 patients
Jia Zeng, Xiao-Xia Qi, Wan-Wan Cai, Ya-Ping Pan, Yi Xie
Jia Zeng, Department of Aviation Disease, Naval Medical Center of PLA, Shanghai 200052, China
Jia Zeng, No. 1 Department of Infection, Optical Valley Campus of Hubei Maternal and Child Health Care Hospital, Wuhan 430073, Hubei Province, China
Xiao-Xia Qi, Department of Traditional Chinese Medicine, Naval Medical Center of PLA, Shanghai 200052, China
Wan-Wan Cai, Department of Naval Diving Medicine, Naval Medical Center of PLA, Shanghai 200052, China
Ya-Ping Pan, Traditional Chinese Medicine, Naval Medical Center of PLA, Shanghai 200052, China
Yi Xie, Department of Hepatobiliary Surgery, Naval Medical Center of PLA, Shanghai 200052, China
Author contributions: Zeng J and Qi XX contributed equally to this work; Zeng J and Qi XX designed the research; Zeng J, Jiang WW, and Pan YP collected and analyzed the clinical data; Zeng J, Qi XX, and Xie Y wrote the manuscript; Xie Y revised the manuscript.
Institutional review board statement: This study was reviewed and approved by the Optical Valley Campus of the Hubei Maternal and Child Health Care Hospital Institutional Review Board (Approval No. FYGG(L)-2020-020) and Naval Medical University Institutional Review Board (Approval No. LW20160040).
Informed consent statement: Patients were not required to give informed consent to this study because the analysis used anonymous clinical data that was obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data is available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jia Zeng, MBBS, Associate Chief Physician, Department of Aviation Disease, Naval Medical Center of PLA, No. 338 Huaihai West Road, Changning District, Shanghai 200052, China. yijiacheng455@163.com
Received: June 22, 2021
Peer-review started: June 22, 2021
First decision: July 5, 2021
Revised: July 28, 2021
Accepted: August 25, 2021
Article in press: August 25, 2021
Published online: November 6, 2021
Processing time: 129 Days and 4.1 Hours
Abstract
BACKGROUND

The novel coronavirus disease 2019 (COVID-19) has spread widely around the world with strong infectivity, rapid mutation and a high mortality rate. Mechanical ventilation has been included in the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial Version 8) as an important treatment for severe and critical COVID-19 patients, but its clinical efficacy in COVID-19 patients is various. Therefore, it is necessary to study the influencing factors on the efficacy of mechanical ventilation in severe and critical COVID-19 patients.

AIM

The aim of this study was to determine the influencing factors on the efficacy of mechanical ventilation in severe and critical COVID-19 patients.

METHODS

A total of 27 severe and critical COVID-19 patients were enrolled in this study and treated with mechanical ventilation at the Optical Valley Campus of Hubei Maternal and Child Health Care Hospital (Wuhan, Hubei Province) from February 20, 2020 to April 5, 2020. According to the final treatment outcomes, the patients were divided into the “effective group” and “death group.” The clinical data of the two groups, such as the treatment process and final outcome, were retrospectively analyzed in order to determine the specific curative effects on the two groups and the reasons for the differences in such curative effects, as well as to explore the factors related to death.

RESULTS

This study enrolled 27 severe and critical COVID-19 patients, including 17 males (63.0%) and 10 females (37.0%). Their ages were 74.41 ± 11.73-years-old, and 19 patients (70.4%) were over 70-years-old. Severe COVID-19 patients over 70-years-old who were treated with mechanical ventilation died in 14 cases (82.4%); thus, this was the peak age. A total of 17 patients died of basic disease, 16 of whom had more than two basic diseases. The basic diseases were hypertension, diabetes, and cardiovascular and cerebrovascular diseases. At the same time, 13 patients (76.5%) died from an abnormal increase in blood glucose. Among them, eight had diabetes before contracting COVID-19 and five had a stress-induced increase in blood glucose after contracting COVID-19. Diabetic ketoacidosis occurred in one case. The use of tocilizumab may be a double-edged sword that carries a certain risk in clinical usage. Among the patients who died, 16 (94.1%) went into septic shock at the end. There were significant differences in the degree of infection, cardiac and renal function, and blood glucose between the death group and effective group.

CONCLUSION

Age, blood glucose, cardiac and renal function, and inflammatory reaction are important indicators of poor prognosis for mechanical ventilation in severe and critical COVID-19 patients.

Keywords: COVID-19; Mechanical ventilation; Efficacy; Factors; Prognosis

Core Tip: A total of 27 severe and critical coronavirus disease 2019 (COVID-19) patients were treated with mechanical ventilation and divided into the “effective group” and “death group” according to the final outcomes of the treatment. There were significant differences in the degree of infection, cardiac and renal function, and blood glucose between the death group and effective group. We found that age, blood glucose, cardiac and renal function, and inflammatory reaction are important indicators of poor prognosis for mechanical ventilation in severe and critical COVID-19 patients.