Résumé
SUMMARY OBJECTIVE: The objective of this study was to assess the predictors of survival among patients with coronavirus disease 2019 who underwent tracheal intubation, as part of a hospital cohort study. METHODS: This retrospective cohort study in the Rio do Sul County Hospital, Santa Catarina, Brazil, from April 2020 to May 2021, focused on patients aged 18 years or older intubated for coronavirus disease 2019. We assessed the 90-day survival of intubated patients by estimating the hazard ratio using a Cox proportional hazards regression model. RESULTS: The study included 132 participants, with an average age of approximately 60 years. Tracheal intubation was successfully accomplished in 97% of cases within two attempts. The overall mortality rate was 62.9%. Notably, mortality rates were significantly higher in patients aged over 60 years (hazard ratio=2.57; 95%CI 1.54-4.29; p<0.001), those with blood oxygen saturation below 85% (hazard ratio=1.92; 95%CI 1.03-3.57; p=0.04), instances where tracheal intubation was carried out using a conventional laryngoscope (hazard ratio=2.59; 95%CI 1.22-5.48; p=0.013), and when performed by emergency physicians (hazard ratio=3.96; 95%CI 1.51-10.4; p=0.005). CONCLUSION: Our analysis unveiled that the risk of death in intubated coronavirus disease 2019 patients is four times higher when an emergency physician, as opposed to an anesthesiologist, leads the tracheal intubation team.
Résumé
SUMMARY OBJECTIVE: This study aimed to analyze the clinical-epidemiological profile, possible risk predictors, and outcomes of patients with coronavirus disease 2019 admitted to the ward of a tertiary care hospital in southern Brazil. Specifically, we describe the demographic characteristics, comorbidities, baseline laboratory findings, clinical course, and survival of these patients. METHODS: This is an observational, retrospective cohort study, performed from January to March 2022, on medical records of patients hospitalized between April 2020 and December 2021 in the coronavirus disease 2019 ward of a tertiary hospital in southern Brazil. RESULTS: Data from 502 hospitalized patients were analyzed, of which 60.2% were male, with a median age of 56 years and 31.7% were over 65 years old. The main symptoms presented were dyspnea/respiratory discomfort (69.9%) and cough (63.1%). The most common comorbidities were obesity, systemic arterial hypertension, and diabetes mellitus. A proportion of 55.8% of 493 patients had PaO2/FiO2<300 mmHg in the first examination performed after admission and 46.0% had a neutrophil/lymphocyte ratio>6.8. Oxygen therapy by Venturi mask or mask with reservoir was used in 34.7% of the patients, and non-invasive ventilation was used in 10.0% of the patients. The majority of the patients (98.4%) used corticosteroids, and the outcome of 82.5% of the hospitalized patients was home discharge. CONCLUSION: After analyzing the clinical and epidemiological profile, it can be concluded that age greater than 65 years and pulmonary involvement >50% are predictors of a worse prognosis for coronavirus disease 2019, as is the need for high-flow oxygen therapy. Corticotherapy, however, proved to be beneficial in the treatment of the disease.