Mechanical ventilation and mortality among 223 critically ill patients with coronavirus disease 2019: A multicentric study in Germany.
Kevin Roedl, Dominik Jarczak, Liina Thasler and 21 others
PMID 33250401WHAT IT FOUND
Critically ill patients with COVID-19 who required mechanical ventilation had a 44% intensive care mortality rate, compared to 7% for those who did not.
Older age, higher comorbidity burden, and pulmonary embolism were independently associated with death in ventilated patients.
Key findings
01Overall ICU mortality was 35%, rising to 44% among patients who received mechanical ventilation versus 7% in those who did not.
02In mechanically ventilated patients, age, Charlson Comorbidity Index, and pulmonary embolism were significantly associated with mortality after adjusting for confounders.
03High-flow nasal cannula and noninvasive ventilation frequently failed, with 74% of noninvasive ventilation users and 88% of high-flow users subsequently requiring invasive mechanical ventilation.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Observational design means associations cannot prove causation, particularly for adjunctive therapies like glucocorticoids or inhaled vasodilators which were more common in non-survivors. Retrospective data collection led to incomplete documentation of some laboratory values. Residual confounding from unmeasured covariates cannot be excluded. Results reflect a German healthcare setting with adequate ICU capacity, which may not generalise to overwhelmed systems. The study did not randomise ventilation strategies, so differences between NIV/HFNC and early intubation are descriptive, not comparative.
Declared interests
No external funding was received. Several authors declared conflicts of interest, including research support, lecture honoraria, and consultant fees from companies manufacturing ventilators, ECMO devices, pharmaceuticals, and critical care supplies.
The easy way to misread this
Do not interpret the high use of adjunctive therapies in non-survivors as evidence that these treatments are harmful. The study is observational, and therapies were likely escalated in the sickest patients. Additionally, do not assume that avoiding mechanical ventilation improves survival; the lower mortality in the non-ventilation group reflects less severe illness at admission, not a protective effect of the treatment strategy itself.