Ventilator avoidance among critically ill COVID-19 patients with acute respiratory distress syndrome. Issue 11 (November 2022)

• Record Type: Journal Article
• Authors: Fletcher, Jeffrey J; Aughenbaugh, Arielle; Svabek, Catherine; Hahn, Peter Y; Grifka, Ronald G
• Is Part Of: Journal of international medical research. Volume 50:Issue 11(2022)
• Publication Date: 2022-11
• Subjects: COVID-19 -- treatment refusal -- medication adherence -- medical noncompliance -- misinformation -- intubation refusal; Medicine -- Periodicals; Pharmacology -- Periodicals; 610.5
• DOI: 10.1177/03000605221135446
• Languages: English
• ISSNs: 0300-0605

Abstract

Objective: To determine the incidence and significance of ventilator avoidance in patients with critical coronavirus disease 2019 (COVID-19). Methods: This prospective observational cohort study evaluated hospital mortality and 1-year functional outcome among critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated acute respiratory distress syndrome (ARDS). The explanatory variable was ventilator avoidance, modeled as 'initial refusal' of intubation (yes/no). Modified Rankin Scale (mRS) scores were obtained from surviving patients (or their surrogates) via phone or email questionnaire. Results: Among patients for whom intubation was recommended ( n = 102), 40 (39%) initially refused (95% confidence interval [CI] 30%, 49%). The risk of death was 79.3% (49/62) in those who did not initially refuse intubation compared with 77.5% (31/40) in those who initially refused, with an adjusted odds ratio for death of 1.27 (95% CI 0.47, 3.48). The distribution of 1-year mRS scores was not significantly different between groups. Conclusion: Among critically ill patients with COVID-19-associated ARDS, ventilator avoidance was common, but was not associated with increased in-hospital mortality or 1-year functional outcome.