Epidemiology of Tracheostomized Adult Patients Admitted to Specialized Weaning Centers After Acute COVID-19.

BACKGROUND: Epidemiological data on patients with COVID-19 referred to specialized weaning centers (SWCs) are sparse, particularly in low- and middle-income countries. Our aim was to describe clinical features, epidemiology, and outcomes of subjects admitted to SWCs in Argentina. METHODS: We conducted a prospective, multi-center, observational study between July 2020-December 2021 in 12 SWCs. We collected demographic characteristics, laboratory results, pulmonary function, and dependence on mechanical ventilation at admission, decannulation, weaning from mechanical ventilation, and status at discharge. A multiple logistic model was built to predict home discharge. RESULTS: We enrolled 568 tracheostomized adult subjects after the acute COVID-19 phase who were transferred to SWCs. Age was 62 [52-71], males 70%, Charlson comorbidity index was 2 [0-3], and length of stay in ICU was 42 [32-56] d. Of the 315 ventilator-dependent subjects, 72.4% were weaned, 427 (75.2%) were decannulated, and 366 subjects (64.5%) were discharged home. The mortality rate was 6.0%. In multivariate analysis, age (odds ratio 0.30 [95% CI 0.16-0.56], P < .001), Charlson comorbidity index (odds ratio 0.43 [95% CI 0.22-0.84], P < .01), mechanical ventilation duration in ICU (odds ratio 0.80 [95% CI 0.72-0.89], P < .001), renal failure (odds ratio 0.40 [95% CI 0.22-0.73], P = .003), and expiratory muscle weakness (odds ratio 0.35 [95% CI 0.19-0.62], P < .001) were independently associated with home discharge. CONCLUSIONS: Most subjects with COVID-19 transferred to SWCs were weaned, achieved decannulation, and were discharged to home. Age, high-comorbidity burden, prolonged mechanical ventilation in ICU, renal failure at admission, and expiratory muscle weakness were inversely associated with home discharge.

Características epidemiológicas y factores de riesgo de los pacientes adultos con Debilidad Adquirida en la Unidad de Cuidados Intensivos / Epidemiological Characteristics and Risk Factors of Adult Patients with Intensive Care Unit-Acquired Weakness

Introducción: La debilidad adquirida en la unidad de cuidados intensivos (DAUCI) compromete tanto a los músculos de las extremidades como el diafragma, asociándose con variables de resultado negativas. El objetivo del estudio fue describir las características epidemiológicas e incidencia de DAUCI en adultos con requerimiento de ventilación mecánica invasiva (VMI) mayor a 72 horas en un Hospital General de Agudos de la Ciudad de Buenos Aires. Método: Estudio de cohorte retrospectivo. Se incluyeron pacientes adultos con requerimiento de VMI por más de 72 horas en la Unidad de Cuidados Intensivos (UCI). Las principales variables de interés registradas fueron: incidencia de DAUCI, días de VMI, estadía y mortalidad tanto en UCI como hospitalaria. Resultados: Se incluyeron 262 pacientes de los cuales 87 (33,21%) intercurrieron con debilidad. No se establecieron diferencias estadísticamente significativas entre los pacientes con y sin DAUCI para las variables edad, motivo de ingreso a VMI, número de antecedentes personales y mortalidad tanto en UCI como hospitalaria. En el presente estudio se establecieron como factores de riesgo independiente al sexo femenino (OR: 1,98; IC 95%: 1,02 ­3,81), delirio (OR 8,4; IC 95%: 4,38-16,11) y días de VMI (OR: 1,05; IC 95%: 1,02-1,08). Conclusiones: El presente estudio nos permitió conocer la incidencia y las características epidemiológicas de los pacientes que presentan DAUCI en una UCI del sistema público de salud de Argentina. Se observó que el sexo femenino, los días de VMI y el delirio en UCI fueron factores de riesgo independiente para DAUCI.

Epidemiological Characteristics and Risk Factors of Adult Patients with Intensive Care Unit-Acquired Weakness

Introduction: Intensive care unit-acquired weakness (ICUAW) affects the muscles of the limbs and diaphragm; and is associated with negative outcome variables. The purpose of this study was to describe the epidemiological characteristics and incidence of ICUAW in adults requiring invasive mechanical ventilation (IMV) for more than 72 hours in a General Hospital for Acute Diseases in the City of Buenos Aires. Method: Retrospective cohort study. We included adult patients requiring IMV for more than 72 hours in the Intensive Care Unit (ICU). The main recorded variables of interest were: incidence of ICUAW, days of IMV, length of stay and mortality both in the ICU and in the hospital. Results: 262 patients were included in the study; 87 of them (33.21%) developed weakness. No statistically significant differences were established between patients with and without ICUAW regarding the variables of age, reason for admission to IMV, medical history and mortality both in the ICU and the hospital. In this study, the variables established as independent risk factors were: female gender (OR: 1,98; 95% CI: 1.02-3.81), delirium (OR 8.4; 95% CI: 4.38-16.11) and days of IMV (OR: 1.05; 95% CI: 1.02-1.08). Conclusions: This study allowed us to know the incidence and epidemiological characteristics of patients with ICUAW in an ICU of the public health system of Argentina. It was observed that female gender, days of IMV and delirium at the ICU were independent risk factors for ICUAW.