Publication date: Jun 30, 2025
End-of-life decision making regarding invasive mechanical ventilation (IMV) for patients with severe coronavirus disease (COVID-19) is challenging. We aimed to explore the factors associated with the withholding of IMV in patients with COVID-19. This retrospective study included patients registered in a nationwide COVID-19 Registry Japan. We enrolled patients with COVID-19 admitted between January 1, 2020, and June 30, 2021, and died during hospitalization. The enrolled patients were divided into two groups: those who received IMV (IMV group) and those who did not (non-IMV group). To identify the factors associated with withholding of IMV among patients with COVID-19 who died during hospitalization, we conducted a multivariate logistic regression analysis. A total of 2,401 patients were enrolled. Of these, 588 (24. 5%) were in the IMV group and 1813 (75. 5%) in the non-IMV group. Withholding IMV was positively associated with older age (95% confidence interval [CI]: 0. 82-0. 88, p < 0. 0001), dementia (95% CI: 0. 81-0. 91, p < 0. 0001), chronic lung disease (95% CI: 0. 88-1. 00, p = 0. 036), and malignancy (95% CI: 0. 82-0. 94, p < 0. 0004) although inversely associated with male sex (95% CI: 1. 04-1. 15, p = 0. 0008), body mass index (95% CI: 1. 01-1. 02, p < 0. 0001), and National Early Warning Score (95% CI: 1. 01-1. 03, p < 0. 0001). We subsequently analyzed these results to inform preparedness for future emerging infectious disease pandemics by retrospectively examining the decision-making processes during the COVID-19 crisis, with particular attention to the role of multidisciplinary collaboration. Based on this study, it will be essential in future pandemics to assess decisions concerning life-sustaining treatments, including IMV, from both scientific and ethical perspectives.
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| Concepts | Keywords |
|---|---|
| Coronavirus | decision-making |
| Dementia | end-of-life |
| June | severe COVID-19 |