CANCOV-Canadian Prospective Cohort of 5-year Outcomes in Critically Ill Patients With COVID-19 Critical Illness and Family Caregivers – Long Term Functional Outcomes After Protective Mechanical Ventilation

Abstract Rationale: Lung protective mechanical ventilation (PMV) decreases ICU mortality in acute respiratory failure but its impact on long-term function in survivors is unclear. We hypothesized that PMV, defined as a static driving pressure<14 cmH2O for the first seven days in ICU, is associated with functional outcome. Methods: This Canadian, multi-center cohort study recruited patients (≥16y) across the COVID-19 illness spectrum. Standardized multidimensional follow-up was performed up to 12 months and every 6 months to 5 years after ICU discharge. This analysis was limited to patients who required mechanical ventilation (MV) within the first seven days of ICU admission. Ventilatory variables were recorded daily during the first week in ICU then twice per week until discharge or death. Using linear regression modelling including a priori variables (age, Charlson Comorbidity Index (CCI), Slope of MODS during first 7 ICU days, ICU length of stay (LOS)), we evaluated the association between the proportion of time spent within PMV parameters during the first 7 days of ICU admission and the Total FIM score at 6-months in survivors. Results: Study sample included ECMO (n=112) and MV (n=190) (n=302). Baseline characteristics (median [IQR]): age 53 [46,61], male [179, 70%], MODS score 10 [8,11], PaO2/FiO2 82 [63,109]. Respiratory variables at ICU admission for ECMO (median [IQR]) and MV only (median [IQR]) respectively: MVdays 43[15,51]; 16[8,26], p<0.001. Tidal volume per predicted body weight (Vt/PBW) 5.0 [4.2,5.7]; 5.9 [5.2,6.4], p<0.001. Respiratory rate 28 [25,34.] 28 [22,30], p=0.010. PEEP 14[10,16.]; 14 [10,16], p=0.887. Plateau Pressure 29 [27,32]; 28 [24,30] p=0.002. Driving Pressure 16 [13,19]; 14[11,16] p<0.001, Respiratory System Compliance 20 [13,27]; 28 [21,37] p<0.001. Volume Assisted-Control Mode 55 (49.1%); 80(42.6%), p=0.325, Pressure Assisted-Control Mode 46 (41%); 39 (21%), p<0.001. Days of continuous sedation 21 [12,31]; 12[6,19]. Days of Continuous Narcotic 26[14,36]; 14[6,23]. Days of Continuous Paralytic 6 [2,18];5.5 [2,12]. In univariable analysis, the proportion of days patients received PMV was not significantly associated with the total FIM at 6 months (-0.226, 95% CI -1.408,0.955, p=0.708). After adjusting for age, ICU LOS, CCI and 7d MODS slope, PMV was not significantly associated with total FIM at 6 months [-0.351, 95% CI -1.972,1.271, p=0.673). Conclusion: In this multi-center study of critically ill COVID-19 survivors, there was no significant association between the proportion of time patients were exposed to PMV during the first seven days in the ICU and the FIM score at 6 months after ICU discharge.

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