Base de datos UCIR.xlsx

BACKGROUND: 15% of COVID-19 patients develop severe pneumonia. Non-invasivemechanical ventilation and high-flow nasal cannula can reduce the rate ofendotracheal intubation in adult respiratory distress syndrome, although failure rate ishigh. OBJECTIVE: To describe the rate of endotracheal intubation, the effectiveness oftreatment, complications and mortality in patients with severe respiratory failure due toCOVID-19. METHODS: Prospective cohort study in a first-level hospital in Madrid.Patients with a positive polymerase chain reaction for SARS-CoV-2 and admitted to theIntermediate Respiratory Care Unit with tachypnea, use of accessory musculature orSpO2 <92% despite FiO2> 0.5 were included. Intubation rate, medical complications,and 28-day mortality were recorded. Statistical analysis through association studies,logistic and Cox regression models and survival analysis was performed. RESULTS:Seventy patients were included. 37.1% required endotracheal intubation, 58.6%suffered medical complications and 24.3% died. Prone positioning was independentlyassociated with lower need for endotracheal intubation (OR 0.05; 95% CI 0.005 to0.54, p=0.001). The adjusted HR for death at 28 days in the group of patients requiringendotracheal intubation was 5.4 (95% CI 1.51 to 19.5; p=0.009). CONCLUSIONS: Therate of endotracheal intubation in patients with severe respiratory failure from COVID-19 was 37.1%. Complications and mortality were lower in patients in whomendotracheal intubation could be avoided. Prone positioning could reduce the need forendotracheal intubation.【背景】15%的新型冠状病毒肺炎（COVID-19）患者会进展为重症肺炎。尽管无创机械通气与高流量鼻导管通气可降低成人急性呼吸窘迫综合征患者的气管插管率，但二者的失败率仍居高不下。 【目的】本研究旨在描述新型冠状病毒肺炎相关重症呼吸衰竭患者的气管插管率、治疗有效性、并发症发生情况及病死率。 【方法】本研究为一项在马德里某一级医疗中心开展的前瞻性队列研究。纳入标准为：严重急性呼吸综合征冠状病毒2（SARS-CoV-2）核酸聚合酶链反应（polymerase chain reaction, PCR）检测呈阳性，且因呼吸急促、辅助呼吸肌参与呼吸或吸入氧浓度（FiO₂）＞0.5时脉搏血氧饱和度（SpO₂）＜92%而收入呼吸中级监护病房的患者。本研究记录了患者的气管插管率、医疗并发症发生情况及28天病死率，并采用关联分析、logistic回归、Cox回归及生存分析进行统计学分析。 【结果】本研究共纳入70例患者。其中37.1%的患者需行气管插管，58.6%的患者出现医疗并发症，24.3%的患者死亡。俯卧位通气与更低的气管插管需求独立相关（OR=0.05；95%置信区间CI：0.005~0.54，P=0.001）。需行气管插管的患者28天死亡校正风险比（HR）为5.4（95%CI：1.51~19.5，P=0.009）。 【结论】新型冠状病毒肺炎相关重症呼吸衰竭患者的气管插管率为37.1%。可避免气管插管的患者并发症发生率与病死率更低。俯卧位通气可降低患者的气管插管需求。