Barotrauma, timing of Tocilizumab and Invasive ventilationas predictors of mortality with inflammatory markers and comorbidities in critically ill COVID-19 patients: A retrospective study

Abstract

Background-Invasive mechanical ventilation is one of the important parameters inpredicting mortality.Mechanically ventilatedCOVID‑19 patients are at a higher risk of barotrauma. Objectives- to determine we the outcomes, factors and predictors associated withintensive care unit (ICU) mortality among critically illCOVID‑19 patients. Methods- A retrospective, observational study conducted in a tertiary level ICU.After approval of the hospital ethics committee, thedata of COVID‑19 patients requiring ICU admissionbetween February 2020 and November 2020 wereanalysed. A total of 563 patients were admitted and included in the study. Universal sampling was done. SPSS (version 22.0) was used for analysis. Results-563 COVID‑19 patients who required ICU admissionswere analysed. Their mean age was 55.9 ± 14.0 yearsand 72.8% of them were males. Hypertension (39.6%)and diabetes (36.6%) were the major comorbiditiesobserved.We observedbarotrauma in 12 (2.1%) patients. A higher proportionof non‑survivors had barotrauma than survivingones (4.3% vs. 1.4%, P = 0.040).we observed no significant difference in survivorsand non‑survivors with respect to the use oftocilizumab (P = 0.07). Conclusion-higher age, the presence of comorbidities, increasedlevels of inflammatory markers, use of mechanicalventilation, barotrauma and the timing of tocilizumabare associated with an increased risk of in‑hospitalmortality in COVID‑19 patients. It is recommended thatfollowinggentlesuctioning of ventilated patients, close monitoring ofrespiratory rate and tidal volume during weaning, andthe judicious use of cough suppressants may reducethe risk of barotrauma.