Full Vaccination Suggested To Lower Mortality in Patients Intubated From COVID-19-Related Acute Respiratory Distress Syndrome

For patients who are intubated from COVID-19–related acute respiratory distress syndrome (ARDS), the total benefits of full COVID-19 vaccination may be associated with lower mortality, according to a study published in the journal JAMA Network Open. This fully-vaccinated patient population had more than a 5% lower mortality rate after intubation compared to those who did not have full vaccination.

“This cohort study found that full vaccination status was associated with lower mortality compared with controls, which suggests that vaccination might be beneficial even among patients who were intubated owing to COVID-19–related ARDS,” the study authors wrote.

The COVID-19 vaccine is effective against the spread of SARS-CoV-2 infection, though breakthrough infections still occur. Although ARDS can occur in any patient, those who are unvaccinated are more likely to develop the disease, which can quickly progress into a deadly condition that requires assistance from invasive mechanical ventilation.

Because it is unclear whether intense mechanical ventilation functions better for vaccinated or unvaccinated individuals, researchers studied the association between mortality and vaccine status of critically ill patients who require intubation from COVID-19-related ARDS. The primary outcome was time from intubation to all-cause intensive care unit mortality.

After enrolling 265 patients into a multicenter cohort study, researchers divided the patients into 2 groups. The first group included participants who were intubated from ARDS after 14 days (but within 5 months) of being fully vaccinated. The control group included participants who were unvaccinated, partially vaccinated, or fully vaccinated within 14 days (or after 5 months) and intubated due to ARDS.

The results showed that patients who were fully vaccinated were older and more likely have comorbid conditions, but “after adjustment for confounders, were less likely to die…compared with patients in the control group.”

Among participants who were intubated from ARDS, 61.5% of fully vaccinated participants died in the intensive care unit compared to 68.2% of those who were not fully vaccinated.

Researchers also found that fully vaccinated patients who were intubated from COVID-19-related ARDS had better lung mechanics and higher oxygen at baseline, which suggests oxygenation may be strongly associated with mortality, especially oxygenation after day 1 of intubation, according to the investigators. Further, bacteremia was 16.6% lower in the fully vaccinated survivors than control group survivors, which may be associated with mortality rate.

“These findings suggest that the total benefits associated with vaccination against COVID-19 may exceed those previously estimated from the prevention of invasive mechanical ventilation alone,” the study authors wrote.

The study had several limitations. Foremost, the amount of patients in the full vaccination cohort cannot allow for accurate estimates of vaccine efficacy. Second, researchers did not include patients who were not intubated, leading to selection bias. Additionally, the study was observational, which may lead to confounding, and there were a lack of data on viral sequencing.

“This knowledge may be useful given the anticipated, ever-increasing prevalence of such infections and may inform discussions with families about the prognosis of intubated patients,” the study authors wrote.

Reference

Grapsa, Eirini, Adamos, Georgios, Andrianopoulos, Ioannis, et al. Association Between Vaccination Status and Mortality Among Intubated Patients With COVID-19–Related Acute Respiratory Distress Syndrome. October 7, 2022. JAMA Netw Open. 2022;5(10):e2235219. doi:10.1001/jamanetworkopen.2022.35219