Weaning Outcomes and Clinical Characteristics of Severe Mechanically Ventilated COVID-19 Patients During the Three Waves of the COVID-19 Pandemic in Israel

David Ovadya; Sireen Abuakar; Kevin Felner

doi:doi:10.11648/j.cmr.20211006.18

| Peer-Reviewed

Weaning Outcomes and Clinical Characteristics of Severe Mechanically Ventilated COVID-19 Patients During the Three Waves of the COVID-19 Pandemic in Israel

David Ovadya, Sireen Abuakar, Kevin Felner

Published in Clinical Medicine Research (Volume 10, Issue 6)

Received: 10 November 2021 Accepted: 8 December 2021 Published: 24 December 2021

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Background: Most of severe COVID-19 patients who survive the intensive care remain mechanically ventilated and require weaning and further rehabilitation. Objectives: This study compares the characteristics and outcomes of severe mechanically ventilated COVID-19 patients admitted to a weaning facility. In addition, the study describes patterns of weaning experienced during the three waves of COVID-19 in Israel. Methods: Clinical, demographic and outcome data was gathered retrospectively for 70 severe mechanically ventilated patients. Univariate analysis was performed to explain the variability in outcome variables. Results: Weaning success was 94% with mean weaning duration of 13±17 days. None of the demographic and clinical variables examined influenced the weaning duration, however patients with morbid obesity and/or diabetes were found to have shorter total duration on mechanical ventilation, hereby suggesting the presence of an obesity paradox. Extra corporal membrane oxygenation (ECMO) was used in 29% of the patients, and didn’t influence the weaning duration in spite being associated with higher rate of pleural complication. There were three main weaning patterns seen in different overlapping levels in the cohort patients: low capacity extra pulmonary pattern, fibrotic-bullosic pulmonary injury pattern and nonspecific interstitial pneumonitis pattern. Conclusions: The current study shows a high success rate of weaning, independent on comorbidities and previous ECMO use.

Published in	Clinical Medicine Research (Volume 10, Issue 6)
DOI	10.11648/j.cmr.20211006.18
Page(s)	225-230
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

COVID-19, Obesity Paradox, Weaning, Mechanical Ventilation

References

[1]	Broderick D, Kyzas P, Baldwin AJ, et al. Surgical tracheostomies in COVID-19 patients: A multidisciplinary approach and lessons learned. Oral Oncol. 2020; 106: 104767. doi: 10.1016/j.oraloncology.2020.104767.
[2]	Grabowski DC, Joynt Maddox KE. Postacute Care Preparedness for COVID-19: Thinking Ahead. JAMA - J Am Med Assoc. 2020. doi: 10.1001/jama.2020.4686.
[3]	Benito DA, Bestourous DE, Tong JY, Pasick LJ, Sataloff RT. Tracheotomy in COVID-19 Patients: A Systematic Review and Meta-analysis of Weaning, Decannulation, and Survival. Otolaryngol Head Neck Surg. 2021 Sep; 165 (3): 398-405. doi: 10.1177/0194599820984780. Epub 2021 Jan 5. PMID: 33399526.
[4]	Lorusso, R., Combes, A., Lo Coco, V. et al. ECMO for COVID-19 patients in Europe and Israel. Intensive Care Med 47, 344–348 (2021).
[5]	Hamilton NJI, Jacob T, Schilder AGM, et al. COVIDTrach; the outcomes of mechanically ventilated COVID-19 patients undergoing tracheostomy in the UK: Interim Report. Br J Surg. 2020; 107 (12): e583-e584. doi: 10.1002/bjs.12020.
[6]	Cardasis JJ, Rasamny JK, Berzofsky CE, Bello JA, Multz AS. Outcomes After Tracheostomy for Patients With Respiratory Failure due to COVID-19: https://doi.org/101177/0145561321993567. Published online February 11, 2021. doi: 10.1177/0145561321993567.
[7]	Abumayyaleh M, Gil IJN, El-Battrawy I, et al. Does there exist an obesity paradox in COVID-19? Insights of the international HOPE-COVID-19-registry. Obes Res Clin Pract. 2021; 15 (3): 275. doi: 10.1016/J.ORCP.2021.02.008.
[8]	Ni Y-N, Luo J, Yu H, et al. Can body mass index predict clinical outcomes for patients with acute lung injury/acute respiratory distress syndrome? A meta-analysis. Crit Care 2017 211. 2017; 21 (1): 1-10. doi: 10.1186/S13054-017-1615-3.
[9]	K J, BH J, MG K, et al. Impact of delirium on weaning from mechanical ventilation in medical patients. Respirology. 2016; 21 (2): 313-320. doi: 10.1111/RESP.12673.
[10]	Choi JH, Luc JGY, Weber MP, et al. Heparin-induced thrombocytopenia during extracorporeal life support: incidence, management and outcomes. Ann Cardiothorac Surg. 2019; 8 (1): 19. doi: 10.21037/ACS.2018.12.02.
[11]	Steinlechner B, Kargl G, Schlömmer C, et al. Can Heparin-Coated ECMO Cannulas Induce Thrombocytopenia in COVID-19 Patients? Case Reports Immunol. 2021; 2021: 1-5. doi: 10.1155/2021/6624682.
[12]	Tornari C, Surda P, Takhar A, et al. Tracheostomy, ventilatory wean, and decannulation in COVID-19 patients. Eur Arch Oto-Rhino-Laryngology. 2021; 278 (5): 1595-1604. doi: 10.1007/s00405-020-06187-1.
[13]	Ovadya D, Bachar K, Peled M, Skudowitz M, Wollner A. Weaning of severe COVID-19 mechanically ventilated patients: experience within a dedicated unit in Israel. Isr Med Assoc J. 2021; 22 (12): 733-735. Accessed June 27, 2021. https://europepmc.org/article/med/33381942.
[14]	Estraneo A, Ciapetti M, Gaudiosi C, Grippo A. Not only pulmonary rehabilitation for critically ill patients with COVID-19. J Neurol. 2021; 268 (1): 1. doi: 10.1007/S00415-020-10077-1.
[15]	Zhou C, Wu L, Ni F, Ji W, Wu J, Zhang H. Critical illness polyneuropathy and myopathy: A systematic review. Neural Regen Res. Published online 2014. doi: 10.4103/1673-5374.125337.
[16]	Solomon IH, Normandin E, Bhattacharyya S, et al. Neuropathological Features of Covid-19. N Engl J Med. 2020; 383 (10): 989-992. doi: 10.1056/NEJMc2019373.
[17]	Salcedo RM, Flores RG, Medina CA, Mogollon RJ, Madariaga MG. Postinfectious Interstitial Pneumonia After COVID-19 Infection. Infect Dis Clin Pract (Baltim Md). 2021; 29 (3): e193. doi: 10.1097/IPC.0000000000000985.
[18]	Cauwelaert S Van, Stylemans D, D’Haenens A, Slabbynck H, Nieuwendijk R. Even if it looks like COVID-19, think again: the importance of differential diagnosis during a pandemic. https://doi.org/101080/1784328620211872312. Published online 2021. doi: 10.1080/17843286.2021.1872312.
[19]	Tanni SE, Fabro AT, Albuquerque A de, et al. Pulmonary fibrosis secondary to COVID-19: a narrative review. https://doi.org/101080/1747634820211916472. Published online 2021. doi: 10.1080/17476348.2021.1916472.
[20]	C M-V, C PM-R, M B-B, M B-S. Outcome of 1890 tracheostomies for critical COVID-19 patients: a national cohort study in Spain. Eur Arch Otorhinolaryngol. 2021; 278 (5). doi: 10.1007/S00405-020-06220-3.

Cite This Article

Plain Text BibTeX RIS

APA Style

David Ovadya, Sireen Abuakar, Kevin Felner. (2021). Weaning Outcomes and Clinical Characteristics of Severe Mechanically Ventilated COVID-19 Patients During the Three Waves of the COVID-19 Pandemic in Israel. Clinical Medicine Research, 10(6), 225-230. https://doi.org/10.11648/j.cmr.20211006.18

Copy | Download

ACS Style

David Ovadya; Sireen Abuakar; Kevin Felner. Weaning Outcomes and Clinical Characteristics of Severe Mechanically Ventilated COVID-19 Patients During the Three Waves of the COVID-19 Pandemic in Israel. Clin. Med. Res. 2021, 10(6), 225-230. doi: 10.11648/j.cmr.20211006.18

Copy | Download

AMA Style

David Ovadya, Sireen Abuakar, Kevin Felner. Weaning Outcomes and Clinical Characteristics of Severe Mechanically Ventilated COVID-19 Patients During the Three Waves of the COVID-19 Pandemic in Israel. Clin Med Res. 2021;10(6):225-230. doi: 10.11648/j.cmr.20211006.18

Copy | Download

@article{10.11648/j.cmr.20211006.18,
  author = {David Ovadya and Sireen Abuakar and Kevin Felner},
  title = {Weaning Outcomes and Clinical Characteristics of Severe Mechanically Ventilated COVID-19 Patients During the Three Waves of the COVID-19 Pandemic in Israel},
  journal = {Clinical Medicine Research},
  volume = {10},
  number = {6},
  pages = {225-230},
  doi = {10.11648/j.cmr.20211006.18},
  url = {https://doi.org/10.11648/j.cmr.20211006.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20211006.18},
  abstract = {Background: Most of severe COVID-19 patients who survive the intensive care remain mechanically ventilated and require weaning and further rehabilitation. Objectives: This study compares the characteristics and outcomes of severe mechanically ventilated COVID-19 patients admitted to a weaning facility. In addition, the study describes patterns of weaning experienced during the three waves of COVID-19 in Israel. Methods: Clinical, demographic and outcome data was gathered retrospectively for 70 severe mechanically ventilated patients. Univariate analysis was performed to explain the variability in outcome variables. Results: Weaning success was 94% with mean weaning duration of 13±17 days. None of the demographic and clinical variables examined influenced the weaning duration, however patients with morbid obesity and/or diabetes were found to have shorter total duration on mechanical ventilation, hereby suggesting the presence of an obesity paradox. Extra corporal membrane oxygenation (ECMO) was used in 29% of the patients, and didn’t influence the weaning duration in spite being associated with higher rate of pleural complication. There were three main weaning patterns seen in different overlapping levels in the cohort patients: low capacity extra pulmonary pattern, fibrotic-bullosic pulmonary injury pattern and nonspecific interstitial pneumonitis pattern. Conclusions: The current study shows a high success rate of weaning, independent on comorbidities and previous ECMO use.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - Weaning Outcomes and Clinical Characteristics of Severe Mechanically Ventilated COVID-19 Patients During the Three Waves of the COVID-19 Pandemic in Israel
AU  - David Ovadya
AU  - Sireen Abuakar
AU  - Kevin Felner
Y1  - 2021/12/24
PY  - 2021
N1  - https://doi.org/10.11648/j.cmr.20211006.18
DO  - 10.11648/j.cmr.20211006.18
T2  - Clinical Medicine Research
JF  - Clinical Medicine Research
JO  - Clinical Medicine Research
SP  - 225
EP  - 230
PB  - Science Publishing Group
SN  - 2326-9057
UR  - https://doi.org/10.11648/j.cmr.20211006.18
AB  - Background: Most of severe COVID-19 patients who survive the intensive care remain mechanically ventilated and require weaning and further rehabilitation. Objectives: This study compares the characteristics and outcomes of severe mechanically ventilated COVID-19 patients admitted to a weaning facility. In addition, the study describes patterns of weaning experienced during the three waves of COVID-19 in Israel. Methods: Clinical, demographic and outcome data was gathered retrospectively for 70 severe mechanically ventilated patients. Univariate analysis was performed to explain the variability in outcome variables. Results: Weaning success was 94% with mean weaning duration of 13±17 days. None of the demographic and clinical variables examined influenced the weaning duration, however patients with morbid obesity and/or diabetes were found to have shorter total duration on mechanical ventilation, hereby suggesting the presence of an obesity paradox. Extra corporal membrane oxygenation (ECMO) was used in 29% of the patients, and didn’t influence the weaning duration in spite being associated with higher rate of pleural complication. There were three main weaning patterns seen in different overlapping levels in the cohort patients: low capacity extra pulmonary pattern, fibrotic-bullosic pulmonary injury pattern and nonspecific interstitial pneumonitis pattern. Conclusions: The current study shows a high success rate of weaning, independent on comorbidities and previous ECMO use.
VL  - 10
IS  - 6
ER  -

Copy | Download

Author Information

David Ovadya

Department of Respiratory Rehabilitation, Sheba Medical Center at Tel-Hashomer, Ramat Gan, Israel
Sireen Abuakar

Department of Respiratory Rehabilitation, Sheba Medical Center at Tel-Hashomer, Ramat Gan, Israel
Kevin Felner

Department of Respiratory Rehabilitation, Sheba Medical Center at Tel-Hashomer, Ramat Gan, Israel

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

David Ovadya, Sireen Abuakar, Kevin Felner. (2021). Weaning Outcomes and Clinical Characteristics of Severe Mechanically Ventilated COVID-19 Patients During the Three Waves of the COVID-19 Pandemic in Israel. Clinical Medicine Research, 10(6), 225-230. https://doi.org/10.11648/j.cmr.20211006.18

Copy | Download

ACS Style

David Ovadya; Sireen Abuakar; Kevin Felner. Weaning Outcomes and Clinical Characteristics of Severe Mechanically Ventilated COVID-19 Patients During the Three Waves of the COVID-19 Pandemic in Israel. Clin. Med. Res. 2021, 10(6), 225-230. doi: 10.11648/j.cmr.20211006.18

Copy | Download

AMA Style

David Ovadya, Sireen Abuakar, Kevin Felner. Weaning Outcomes and Clinical Characteristics of Severe Mechanically Ventilated COVID-19 Patients During the Three Waves of the COVID-19 Pandemic in Israel. Clin Med Res. 2021;10(6):225-230. doi: 10.11648/j.cmr.20211006.18

Copy | Download

@article{10.11648/j.cmr.20211006.18,
  author = {David Ovadya and Sireen Abuakar and Kevin Felner},
  title = {Weaning Outcomes and Clinical Characteristics of Severe Mechanically Ventilated COVID-19 Patients During the Three Waves of the COVID-19 Pandemic in Israel},
  journal = {Clinical Medicine Research},
  volume = {10},
  number = {6},
  pages = {225-230},
  doi = {10.11648/j.cmr.20211006.18},
  url = {https://doi.org/10.11648/j.cmr.20211006.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20211006.18},
  abstract = {Background: Most of severe COVID-19 patients who survive the intensive care remain mechanically ventilated and require weaning and further rehabilitation. Objectives: This study compares the characteristics and outcomes of severe mechanically ventilated COVID-19 patients admitted to a weaning facility. In addition, the study describes patterns of weaning experienced during the three waves of COVID-19 in Israel. Methods: Clinical, demographic and outcome data was gathered retrospectively for 70 severe mechanically ventilated patients. Univariate analysis was performed to explain the variability in outcome variables. Results: Weaning success was 94% with mean weaning duration of 13±17 days. None of the demographic and clinical variables examined influenced the weaning duration, however patients with morbid obesity and/or diabetes were found to have shorter total duration on mechanical ventilation, hereby suggesting the presence of an obesity paradox. Extra corporal membrane oxygenation (ECMO) was used in 29% of the patients, and didn’t influence the weaning duration in spite being associated with higher rate of pleural complication. There were three main weaning patterns seen in different overlapping levels in the cohort patients: low capacity extra pulmonary pattern, fibrotic-bullosic pulmonary injury pattern and nonspecific interstitial pneumonitis pattern. Conclusions: The current study shows a high success rate of weaning, independent on comorbidities and previous ECMO use.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - Weaning Outcomes and Clinical Characteristics of Severe Mechanically Ventilated COVID-19 Patients During the Three Waves of the COVID-19 Pandemic in Israel
AU  - David Ovadya
AU  - Sireen Abuakar
AU  - Kevin Felner
Y1  - 2021/12/24
PY  - 2021
N1  - https://doi.org/10.11648/j.cmr.20211006.18
DO  - 10.11648/j.cmr.20211006.18
T2  - Clinical Medicine Research
JF  - Clinical Medicine Research
JO  - Clinical Medicine Research
SP  - 225
EP  - 230
PB  - Science Publishing Group
SN  - 2326-9057
UR  - https://doi.org/10.11648/j.cmr.20211006.18
AB  - Background: Most of severe COVID-19 patients who survive the intensive care remain mechanically ventilated and require weaning and further rehabilitation. Objectives: This study compares the characteristics and outcomes of severe mechanically ventilated COVID-19 patients admitted to a weaning facility. In addition, the study describes patterns of weaning experienced during the three waves of COVID-19 in Israel. Methods: Clinical, demographic and outcome data was gathered retrospectively for 70 severe mechanically ventilated patients. Univariate analysis was performed to explain the variability in outcome variables. Results: Weaning success was 94% with mean weaning duration of 13±17 days. None of the demographic and clinical variables examined influenced the weaning duration, however patients with morbid obesity and/or diabetes were found to have shorter total duration on mechanical ventilation, hereby suggesting the presence of an obesity paradox. Extra corporal membrane oxygenation (ECMO) was used in 29% of the patients, and didn’t influence the weaning duration in spite being associated with higher rate of pleural complication. There were three main weaning patterns seen in different overlapping levels in the cohort patients: low capacity extra pulmonary pattern, fibrotic-bullosic pulmonary injury pattern and nonspecific interstitial pneumonitis pattern. Conclusions: The current study shows a high success rate of weaning, independent on comorbidities and previous ECMO use.
VL  - 10
IS  - 6
ER  -

Copy | Download