@article {Burns3607976, author = {Gregory D Burns and Justin Phillips and Lance Pingul Pangilinan and Richard Kallet}, title = {Time to Extubation With and Without COVID-19 Pneumonia}, volume = {66}, number = {Suppl 10}, elocation-id = {3607976}, year = {2021}, publisher = {Respiratory Care}, abstract = {Background: Coronavirus disease 2019-associated ARDS (or CARDS) often requires invasive mechanical ventilation. Early on during the pandemic there was a perception that CARDS was associated with prolonged mechanical ventilation. This retrospective study assessed the characteristics and outcomes of both ARDS and CARDS subjects during the first 6 months of the COVID-19 pandemic. The primary objective was to ascertain whether subjects with CARDS had a longer mechanical ventilation duration than other forms of ARDS. Methods: Between March 1st and August 12th, 2020, we identified a total of 73 subjects for inclusion with either CARDS (37) or ARDS (36) who were managed with the ARDSnet ventilator protocol. Exclusion criteria were: \<18 years of age, required tracheostomy, ECMO or failed extubation \< 48 h. IRB approval was obtained with a waiver of consent. Demographic and baseline clinical data were collected at ARDS onset (ARDS day 0), with subsequent longitudinal data collected on ARDS days 1{\textendash}3, 5, 7, 10, 14, and 21. Comparisons were made using Wilcoxon rank sum test (continuous variables), Chi squared test (categorical variables) stratified by COVID-19 status. A Kaplan Meier plot was used for extubation, and the log rank test used to assess significance. A Cox proportional hazards model was used to estimate the adjusted hazard ratio for extubation. Alpha was set at 0.05. Results: At ARDS onset, those meeting severe criteria (Berlin definition) was similar between CARDS (24\%) vs. ARDS (27\%), P = 0.81. Median [IQR] mechanical ventilation duration was longer in CARDS vs. ARDS: 10 [6{\textendash}20] vs. 4 [2{\textendash}8] d, P \<0.001) (Figure 1). In the Cox proportional hazard analysis COVID-19 pneumonia was independently associated with a 30\% decrease in the rate of achieving unassisted breathing, but this was not statistically significant (P = 0.36, 95\% CI -68\% to 51\%). However, the rate of achieving unassisted breathing significantly increased by 31\% per 10 mL/H2O increase in CRS (P = 0.04, 95\% CI 1\% to 68\%). Conclusions: MV days is prolonged in CARDS when compared to ARDS, and may be independently associated with changes in CRS.}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/66/Suppl_10/3607976}, eprint = {https://rc.rcjournal.com/content}, journal = {Respiratory Care} }