RESUMEN
The mortality rate of patients with COVID-19 pneumonia requiring mechanical ventilation remains high. This study determined the percentage and characteristics of patients who developed lung abscesses or pyothorax and their mortality rates among adult patients with COVID-19 admitted to the ICU who required mechanical ventilation. Of the 64 patients with COVID-19 assessed, 30 (47%) developed ventilator-associated pneumonia (VAP), of whom 6 (20%) developed pyothorax or lung abscess. There were no statistically significant differences in patient characteristics, treatment after ICU admission, or outcomes between those with and without these complications, except for age. VAP complicated by Lung abscess or pyothorax was caused by a single organism, with Staphylococcus aureus (n = 4) and Klebsiella species (n = 2) being the primary causative agents. Occur infrequently in patients with COVID-19 requiring mechanical ventilation. Large-scale studies are required to elucidate their effects on clinical outcomes.
RESUMEN
The benefits of introducing a systematic lung-protective protocol for coronavirus disease 2019 (COVID-19) pneumonia requiring invasive ventilation in the intensive care unit (ICU) are unknown. Herein, we aimed to evaluate the clinical effects of introducing such a protocol in terms of mortality, duration of ventilation, and length of ICU stay. In this single-centre, retrospective, quality comparison study, we identified patients with COVID-19 pneumonia who received invasive ventilation in our ICU between February 2020 and October 2021. We established a systematic lung-protective protocol for the pre-introduction group until March 2021 and the post-introduction group after April 2021. Patients who did not receive invasive ventilation and who underwent veno-venous extracorporeal membrane oxygenation in a referring hospital were excluded. We collected patient characteristics at the time of ICU admission, including age, sex, body mass index (BMI), comorbidities, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, and Murray score. The study outcomes were ICU mortality, length of ICU stay, and duration of ventilation. The pre-introduction and post-introduction groups included 18 and 50 patients, respectively. No significant differences were observed in sex, BMI, SOFA score, APACHE II score, and Murray score; however, age was lower in the post-introduction group (70 vs. 56, P = 0.003). The introduction of this protocol did not improve ICU mortality. However, it reduced the ICU length of stay (26 days vs. 11 days, P = 0.003) and tended to shorten the duration of ventilation (15 days vs. 10 days, P = 0.06). The introduction of the protocol was associated with a decrease in the length of ICU stay and duration of ventilation; however, it did not change mortality. The application of the protocol could improve the security of medical resources during the COVID-19 pandemic. Further prospective multicentre studies are needed.