Mechanical ventilation and outcomes in COVID-19 patients admitted to intensive care unit in a low-resources setting: A retrospective study

Abstract

Objective: To describe the strategies and outcomes of mechanical ventilation in a poorly equipped facility. Methods: This retrospective descriptive study included patients with COVID-19 who were admitted to the intensive care unit (ICU) and mechanically ventilated between September 1, 2020, and May 31, 2021. Data were collected from medical records and databases. Results: 54 Patients aged (62.9±13.3) years were included. Among these cases, 79.6% had at least one comorbidity. On admission, all patients had hypoxia. The median peripheral oxygen saturation in room air was 76% (61%, 83%). Non-invasive ventilation (NIV) was performed in 75.9% of the patients, and invasive mechanical ventilation (IMV) in 68.5%. IMV was performed on patients due to severe coma (8.1%), failure of standard oxygen therapy (27.0%), and failure of NIV (64.9%). An arterial blood gas test was performed in 14.8% of the patients. NIV failed in 90.2% of cases and succeeded in 9.8%. IMV was successful in 5.4% of cases, vs. 94.6% of mortality. The overall mortality rate of patients on ventilation in the ICU was 88.9%. The causes of death included severe respiratory distress syndrome (85.2%), multiple organ failure (14.8%), and pulmonary embolism (13.0%). Conclusions: The ventilation management of COVID-19 patients in the ICU with NIV and IMV in a scarce resource setting is associated with a high mortality rate. Shortcomings are identified in ventilation strategies, protocols, and monitoring. Required improvements were also proposed.

Keywords

• coronavirus disease 2019; intensive care unit; hy-poxia; invasive ventilation; non-invasive ventilation; arterial blood gas