Risk Factors and Outcomes Associated With Reintubation Secondary to Respiratory Failure in COVID-19 Subjects With ARDS.

COVID-19 is associated with variable symptoms and clinical sequelae. Patients who develop respiratory failure and progress to ARDS often have worse outcomes. Studies have examined the clinical course of these patients, finding a prolonged need for invasive ventilation and variable reintubation rates. However, no research has investigated factors and outcomes related to reintubation secondary to respiratory failure among COVID-19 patients with ARDS. We conducted a single-center, retrospective study on subjects intubated for ARDS secondary to COVID-19. Included subjects had ARDS upon intubation, ventilated for ≥ 24 h, passed a spontaneous breathing trial (SBT), and were electively extubated. The primary outcome was reintubation status; secondary outcomes were hospital and ICU length of stay and mortality. Using a standardized format, we collected various data from the EMR. Data analyzed using SAS, with between-group comparisons using chi-square testing for categorical information and Student t-test for quantitative data. Univariate and multivariate logistic regression was performed to determine factors related to reintubation and mortality as dependent variables. One hundred fourteen subjects were included, of which(32%) required reintubation. No between-group differences detected for most demographic variables or comorbidities. No differences detected in COVID-19 treatments, noninvasive respiratory support, mechanical circulatory support, or duration of ventilation. Midazolam(OR 5.55[95%CI 1.83-16.8];=.002), fentanyl(OR 3.64[95%CI 1.26-10.52;=.02), and APACHE-II scores(OR 1.08[95% CI 1.03-1.147;=.005) were independently associated with reintubation(AUC=.81). Reintubated subjects had extended hospital(36.7±22.7d vs.26.1±12.1d;=.01) and ICU(29.6±22.4d vs. 15.8±10.4d;<.001) stay. More subjects died who failed extubation(49% vs.3%;<.001). Age (OR 1.07[95%CI: 1.02-1.23];=.005), male sex(OR 4.9[95% CI 1.08-22.35];=.04), positive CAM-ICU(OR 5.43[95% CI 1.58-18.62]; =.007), and reintubation (OR 12.75[95% CI 2.80-57.1];<.001)were independently associated with death(AUC=.93). Midazolam, fentanyl, and higher APACHE-II scores were independently associated with reintubation secondary to respiratory failure in subjects with COVID-19-related ARDS. Furthermore, age, male sex, positive CAM-ICU, and reintubation were independently associated with mortality. Reintubation also correlated with prolonged hospital and ICU stay.