High mortality among patients with severe COVID-19 and Do Not Intubate orders
Danish Medical Journal
; 69(12), 2022.
Article
in English
| GIM | ID: covidwho-2323626
ABSTRACT
INTRODUCTION. Moderate to severe respiratory distress among patients with COVID-19 is associated with a high mortality. This study evaluated ventilator support and mortality by Do Intubate (DI) or Do Not Intubate (DNI) orders. METHODS. This was a retrospective study of patients with COVID-19 and a supplemental oxygen requirement of 15 l/min. The patients were divided into two groups corresponding to the first and second wave of COVID-19 and were subsequently further divided according to DI and DNI orders and analysed regarding need of ventilator support and mortality. RESULTS. The study included 178 patients. The mortality was 24% for patients with DI orders (n = 115) and 81% for patients with DNI orders (n = 63) increasing to 98% (n = 46) for patients with DNI orders and very high flow oxygen requirements ( 30 l/min.). From the first to the second wave of COVID-19, the use of constant continuous positive airway pressure (cCPAP) increased from 71% to 91% (p < 0.001), whereas the use of mechanical ventilation decreased from 54% to 28% (odds ratio = 0.38 (95% confidence interval 0.17-0.85)). CONCLUSION. The mortality was high for patients with DNI orders and respiratory distress with very high levels in supplemental oxygen in both the first and second wave of COVID-19 despite an increase in use of cCPAP and treatment with dexamethasone and remdesivir during the second wave. Hence, careful evaluation on transition to palliative care must be considered for these patients.
7782-44-7; 16978-57-7; 1879-72-7; 1926-94-9; 2265-67-7; 2392-39-4; 312-93-6; 50-02-2; 55812-90-3; 7743-96-6; 1809249-37-3; mortality; coronavirus disease 2019; viral diseases; human diseases; patients; severe course; severe infections; retrospective studies; oxygen; oxygen requirement; respiratory diseases; lungs; ventilators; dexamethasone; remdesivir; palliative care; drug therapy; epidemiology; acute course; acute infections; Severe acute respiratory syndrome coronavirus 2; man; Denmark; Nordic Countries; Severe acute respiratory syndrome-related coronavirus; Betacoronavirus; Coronavirinae; Coronaviridae; Nidovirales; positive-sense ssRNA Viruses; ssRNA Viruses; RNA Viruses; viruses; Homo; Hominidae; primates; mammals; vertebrates; Chordata; animals; eukaryotes; European Union Countries; high income countries; OECD Countries; Scandinavia; Northern Europe; Europe; very high Human Development Index countries; death rate; SARS-CoV-2; viral infections; oxygen demand; lung diseases; chemotherapy
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Collection:
Databases of international organizations
Database:
GIM
Type of study:
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Language:
English
Journal:
Danish Medical Journal
Year:
2022
Document Type:
Article
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