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Reduced survival in patients requiring chest tubes with COVID-19 acute respiratory distress syndrome.

ABSTRACT:

Background

Numerous complications requiring tube thoracostomy have been reported among critically ill patients with COVID-19; however, there has been a lack of evidence regarding outcomes following chest tube placement.

Methods

We developed a retrospective observational cohort of all patients admitted to an intensive care unit (ICU) with confirmed COVID-19 to describe the incidence of tube thoracostomy and factors associated with mortality following chest tube placement.

Results

In total, 1705 patients with laboratory confirmed COVID-19 patients were admitted to our ICUs from March 7, 2020, to March 1, 2021, with 69 out of 1705 patients (4.0%) receiving 130 chest tubes. Of these, 89 out of 130 (68%) chest tubes were indicated for pneumothorax. Patients receiving tube thoracostomy were much less likely to be alive 90 days post-ICU admission (52% vs 69%; P < .01), and had longer ICU (30 vs 5 days; P < .01) and hospital (37 vs 10 days; P < .01) lengths of stay compared with those without tube thoracostomy. Patients who received tube thoracostomy and survived at least 90 days post-ICU admission had shorter times to first chest tube insertion (8.5 vs 17.0 days; P = .01) and a nonsignificantly higher static compliance (20.0 vs 17.5 mL/cm H₂O; P = .052) at the time of chest tube placement than those who had expired. Logistic regression analysis demonstrated an association between time to first chest tube and decreased survival when adjusted for covariates.

Conclusions

Requiring a chest tube in COVID-19 is a negative prognostic end point. Delayed development of chest tube requirement was associated with a decreased survival and could reflect a poor healing phenotype.

SUBMITTER: Rizer NW

PROVIDER: S-EPMC9020834 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectivesTo describe 3-6-month neurologic outcomes of survivors of COVID-19-associated acute respiratory distress syndrome, invasively ventilated in the ICU.DesignA bicentric prospective study during the two first waves of the pandemic (March to May and September to December, 2020).SettingTwo academic hospital ICUs, Paris, France.PatientsAdult COVID-19-associated acute respiratory distress syndrome survivors, invasively ventilated in the ICU, were eligible for a neurologic consultation between 3 and 6 months post ICU discharge.InterventionsFollow-up by face-to-face neurologic consultation.Measures and main resultsThe primary endpoint was favorable functional outcome defined by a modified Rankin scale score less than 2, indicating survival with no significant disability. Secondary endpoints included mild cognitive impairment (Montreal Cognitive Assessment score < 26), ICU-acquired weakness (Medical Research Council score < 48), anxiety and depression (Hospital Anxiety and Depression score > 7), and posttraumatic stress disorder (posttraumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders 5 score > 30). Of 54 eligible survivors, four non-French-speaking patients were excluded, eight patients were lost-to-follow-up, and one died during follow-up. Forty-one patients were included. Time between ICU discharge and neurologic consultation was 3.8 months (3.6-5.9 mo). A favorable functional outcome was observed in 16 patients (39%) and mild cognitive impairment in 17 of 33 patients tested (52%). ICU-acquired weakness, depression or anxiety, and posttraumatic stress disorder were reported in six of 37 cases (16%), eight of 31 cases (26%), and two of 27 cases (7%), respectively. Twenty-nine patients (74%) required rehabilitation (motor, cognitive, or psychologic). ICU and hospital lengths of stay, tracheostomy, and corticosteroids were negatively associated with favorable outcome. By contrast, use of alpha-2 agonists during ICU stay was associated with favorable outcome.ConclusionsCOVID-19-associated acute respiratory distress syndrome requiring intubation led to slight-to-severe functional disability in about 60% of survivors 4 months after ICU discharge. Cognitive impairment, muscle weakness, and psychologic symptoms were frequent. A large multicenter study is warranted to allow identification of modifiable factors for improving long-term outcome.