A descriptive study of the surge response and outcomes of ICU patients with COVID‐19 during first wave in Nordic countries

Abstract

Background We sought to provide a description of surge response strategies and characteristics, clinical management and outcomes of patients with severe COVID‐19 in the intensive care unit (ICU) during the first wave of the pandemic in Denmark, Finland, Iceland, Norway and Sweden. Methods Representatives from the national ICU registries for each of the five countries provided clinical data and a description of the strategies to allocate ICU resources and increase the ICU capacity during the pandemic. All adult patients admitted to the ICU for COVID‐19 disease during the first wave of COVID‐19 were included. The clinical characteristics, ICU management and outcomes of individual countries were described with descriptive statistics. Results Most countries more than doubled their ICU capacity during the pandemic. For patients positive for SARS‐CoV‐2, the ratio of requiring ICU admission for COVID‐19 varied substantially (1.6%–6.7%). Apart from age (proportion of patients aged 65 years or over between 29% and 62%), baseline characteristics, chronic comorbidity burden and acute presentations of COVID‐19 disease were similar among the five countries. While utilization of invasive mechanical ventilation was high (59%–85%) in all countries, the proportion of patients receiving renal replacement therapy (7%–26%) and various experimental therapies for COVID‐19 disease varied substantially (e.g. use of hydroxychloroquine 0%–85%). Crude ICU mortality ranged from 11% to 33%. Conclusion There was substantial variability in the critical care response in Nordic ICUs to the first wave of COVID‐19 pandemic, including usage of experimental medications. While ICU mortality was low in all countries, the observed variability warrants further attention.

Patient characteristics, management and outcomes in a Nordic subset of the “large observational study to understand the global impact of severe acute respiratory failure” (LUNG SAFE) study

“…This study indicates that adherence to such practices was low at the time the LUNG SAFE study was conducted: Tidal volumes were frequently higher than recommended, and prone ventilation and neuromuscular blockade may have been underutilised. Nordic registry data from the first wave of the SARS‐CoV‐2 pandemic (spring 2020) serve to illustrate that practices have evolved; 38%–48% of ICU‐patients with Covid‐19 were ventilated in the prone position, as compared to only 8% in this LUNG SAFE subset 18 . Under‐recognition of ARDS does, however, does not appear to have made a differential impact on the management of these patients or their outcomes.…”

“…Conversely, Nordic registry data suggest that critically ill patients with Covid-19 were characterised by prolonged mechanical ventilation and ICU LOS. 18 Case-mix, admission and discharge policies, need for isolation, adjunctive measures (proning and neuromuscular blockade)…”

“…Mechanical ventilation and ICU LOS was generally of short duration (median 3 and 5 days, respectively) when compared with global data, 9 Hospital LOS was considerably longer (median 11 days). Conversely, Nordic registry data suggest that critically ill patients with Covid‐19 were characterised by prolonged mechanical ventilation and ICU LOS 18 . Case‐mix, admission and discharge policies, need for isolation, adjunctive measures (proning and neuromuscular blockade) and bed capacities may explain such differences 24 .…”

Therapeutics and COVID‐19—A living WHO guideline: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

“…Severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) has caused a pandemic of coronavirus disease 2019 (COVID‐19), 1 including in the Nordic countries. 2 Many patients have suffered from severe hypoxic respiratory failure and have died, and most healthcare systems worldwide have been overwhelmed by the surge of patients needing hospitalisation and intensive care. 3 , 4…”

Resilience in health care, important for anesthesia and intensive care

“…In our part of the world the impact from COVID-19 has been largest in Sweden, with more than twice as many ICU admissions as the rest of the Nordic countries combined. 1 Hopefully, the world will return to a more normal daily life, so also for our health care systems, but the prospect that the COVID-19 virus will stay with us for a long time is possible. 2 What then can we learn from the way our health care systems met probably the largest challenges in modern time?…”