Mechanical Ventilation for COVID-19: Outcomes Following Discharge from Inpatient Treatment

Mark J. Butler, Jennie H. Best, Shalini V. Mohan, Jennifer A. Jonas, Lindsay Arader, Jackson Yeh

Abstract
Though mechanical ventilation (MV) is used to treat patients with severe coronavirus disease 2019 (COVID-19), little is known about the long-term health implications of this treatment. Our objective was to determine the association between MV for treatment of COVID-19 and likelihood of hospital readmission, all-cause mortality, and reason for readmission. This study was a longitudinal observational design with electronic health record (EHR) data collected between 3/1/2020 and 1/31/2021.

Introduction
Patients with coronavirus disease 2019 (COVID-19) often suffer severe symptoms—from viral pneumonia to respiratory distress. This respiratory distress can lead to alveolar damage and fibrosis in the lungs, which reduces oxygen saturation in the blood. COVID-19–related respiratory distress has been associated with higher rates of mortality and intensive care unit (ICU) admission than respiratory distress associated with other illnesses.

Methods:

Study design and participants
This was a longitudinal observational study using electronic health record (EHR) data from the Northwell Health system. Northwell Health is a healthcare system that comprises 23 hospitals/medical facilities serving New York City, Long Island, and the surrounding area. This region was one of the epicenters of the COVID-19 pandemic in the United States.

Mechanical ventilation status
Patients who received MV at any point during their initial inpatient treatment for COVID-19 were defined as “ventilated.” Patients who were treated and discharged from their initial hospitalization without receiving MV were defined as “non-ventilated.”

Discussion
Results of the current study demonstrate that individuals hospitalized with COVID-19 and treated with MV have a greater likelihood of adverse outcomes, including readmission to the hospital and all-cause mortality, following discharge from inpatient care than non-MV patients. Further, MV patients who were readmitted were more likely to be readmitted for COVID-19 illness, infectious diseases, and respiratory diagnoses than non-MV patients.

Acknowledgments
MB, JB, SM, JJ, and LA were responsible for drafting the manuscript. JY secured access to the data. MB, LA, and JY conducted statistical analyses. SM and JJ provided clinical expertise.

Citation: Butler MJ, Best JH, Mohan SV, Jonas JA, Arader L, Yeh J (2023) Mechanical ventilation for COVID-19: Outcomes following discharge from inpatient treatment. PLoS ONE 18(1): e0277498. https://doi.org/10.1371/journal.pone.0277498

Editor: Masaki Tago, Saga University Hospital, JAPAN

Received: May 20, 2022; Accepted: October 1, 2022; Published: January 6, 2023.

Copyright: © 2023 Butler et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The current study looks at outcomes for patients who received mechanical ventilation (MV) for COVID-19 illness relative to a matched cohort of patients who did not. To comply with Safe Harbor de-identification standards, some variables are omitted from the data posted on Open Science. The goal for removing this information is to prevent disclosure of personal health information (PHI). If you would like access to the full data, please contact Dr. Mark Butler (Study Primary Author, Institute of Health System Science, Northwell Health), Challace Pahlevan-Ibrekic (Director, Regulatory Affairs, Institute of Health System Science, Northwell Health), and Suzanne Ardito (Project Manager, Regulatory Affairs, Institute of Health System Science (IHSS), Northwell Health). Data requests can be made via email to markbutler@northwell.edu, cpahlevanibr@northwell.edu, and SArdito@northwell.edu. Data requests will be reviewed by the regulatory team and access to full data will be granted following Institutional Review Board (IRB) approval, as applicable, and completion of a data use and sharing agreement with Northwell Health.

Funding: JY received funding from the National Institute of Aging, grant R24AG064191 (https://www.nia.nih.gov/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.