Incidence, Characteristics, and Outcomes of Ventilator-Associated Events during the COVID-19 Pandemic.

Abstract

RATIONALE\nVentilator-associated event (VAE) surveillance provides an objective means to measure and compare complications that develop during mechanical ventilation by identifying patients with sustained increases in ventilator settings after a period of stable or decreasing ventilator settings. The impact of the Covid-19 pandemic on VAE rates and characteristics is unknown.\n\n\nOBJECTIVES\nTo compare the incidence, causes, and outcomes of VAE during the Covid-19 pandemic year vs pre-pandemic years and amongst ventilated patients with and without Covid-19.\n\n\nMETHODS\nIn this retrospective cohort study of mechanically ventilated adults at four academic and community hospitals in Massachusetts, we compared VAE incidence rates between March 1-August 31 for each of 2017-2020 (corresponding to the timeframe of the pandemic first wave in 2020) and among Covid-19 positive and negative patients in 2020. The medical records of 200 randomly selected patients with VAEs in 2020 (100 with Covid-19, 100 without) were analyzed to compare conditions precipitating VAEs in patients with vs without Covid-19.\n\n\nRESULTS\nVAEs per 100 episodes of mechanical ventilation were more common in 2020 vs prior years (11.2 vs 6.7, p<.01) but the rate of VAEs per 1000 ventilator-days was similar (14.2 vs 12.7, p=.08). VAEs were more frequent in Covid-19 positive vs negative patients within 2020 (29.0 vs. 7.1 per 100 ventilator episodes, p<.01 and 17.2 vs 12.2 per 1000 ventilator days, p<.01). Compared to non-Covid-19 patients with VAEs, Covid-19 patients with VAEs had similar rates of infection-related ventilator-associated complications, longer median duration of mechanical ventilation (22 vs 14 days, p<.01), and similar in-hospital mortality (30% vs 38%, p=.15). Progressive ARDS accounted for 53% of VAEs in Covid-19 patients versus 14% amongst non-Covid-19 patients.\n\n\nCONCLUSIONS\nVAE rates per 100 episodes of mechanical ventilation and per 1000 ventilator days were higher amongst Covid-19 positive versus negative patients. Over 50% of VAEs in Covid-19 patients were caused by progressive ARDS versus less than 15% in patients without Covid-19. These findings provide insight into the natural history of Covid-19 in ventilated patients and may inform targeted strategies to mitigate complications in this population.