Study Confirms Critically Ill Patients with COVID-19 Benefit from Mechanical Ventilation

Researchers help settle debate based on clinical anecdotes

BOSTON—Many patients with COVID-19 who are admitted to the intensive care unit (ICU) require support from a ventilator due to respiratory failure. Physicians around the world have observed that patients with COVID-19 may develop a severe lung condition known as acute respiratory distress syndrome (ARDS), a consequence of pulmonary infections and other illnesses. Decades of studies have established the best methods of mechanical ventilation to treat ARDS. However, recent anecdotal reports from some clinicians raised the question of whether COVID-19 related respiratory distress is ARDS or a new, unknown lung injury that warrants a different treatment strategy.

To help settle the question, pulmonary and critical care specialists at Beth Israel Deaconess Medical Center (BIDMC) and Massachusetts General Hospital (MGH) studied the respiratory characteristics and response of patients with COVID-19 respiratory failure treated with invasive mechanical ventilation at the two tertiary care hospitals. The team’s results, published in the American Journal of Respiratory and Critical Care Medicine, supported the use of established respiratory therapy for treatment of COVID-19.

“We provided all of our patients with the best known evidence-based treatments for ARDS, and patients had improved oxygen levels, decreased need for breathing assistance, and ultimately most were able to come off of the ventilator,” said BIDMC pulmonary specialist Ari Moskowitz, MD, also an Assistant Professor of Medicine at Harvard Medical School.

Moskowitiz and colleagues, including Jason H. Maley, MD and Camille R. Petri, MD, both clinical and research fellows in the Harvard Combined Pulmonary and Critical Care Fellowship, studied a total of 66 adult inpatients with laboratory-confirmed COVID- 19 who were intubated and admitted to ICUs at BIDMC and MGH. All patients were managed with the best established ARDS therapies.

Patient follow-up a minimum of 30 days after admission revealed that the majority (75 percent) of patients were successfully extubated and discharged from the ICU. Overall, eleven patients (16.7 percent) died. Previous data from COVID-19 related ICU admissions in the United States report mortality rates ranging from 25 to 50 percent. The authors emphasized that successful outcomes at the two hospitals are likely a result of providing evidence-based therapies and maintaining a focus on high quality critical care. Both of these factors depend on a large team of expert nurses, respiratory therapists, physicians, and many other critical staff members.

During hospitalization, patients’ oxygenation improved with prone, or face down, positioning — part of the gold standard treatment for ARDS that has been shown to improve oxygen levels in the lungs of patients with typical ARDS. Moreover, the team’s data characterizing patient lung characteristics contradict prior anecdotes that COVID-19 respiratory failure differs from typical ARDS.

“By performing this study, we now have a better understanding of the respiratory failure caused by severe COVID-19,” said Maley. “Our study suggests that proven treatment strategies for ARDS are safe and effective for patients with severe COVID-19. We hope these findings will help clinicians who are treating patients with severe COVID-19 around the world.”

Authors included co-first author David R. Ziehr, MD, of MGH and BIDMC; corresponding author Jehan Alladina, MD; Benjamin D. Medoff, MD; Kathryn A. Hibbert, MD; B.Taylor Thompson, MD;C. Corey Hardin, MD, PhD, of MGH.