Clinical Characteristics, Respiratory Mechanics, and Outcomes in Critically Ill Individuals With COVID-19 Infection in an Underserved Urban Population

Abstract

BACKGROUND:The COVID-19 outbreak in the United States has disproportionately affected Black individuals, but little is known about the factors that underlie this observation. Herein, we describe these associations with mortality in a largely minority underserved population. METHODS: This single-center retrospective observational study included all adult subjects with laboratory-confirmed SARS-Cov-2 treated in our ICU between March 15 and May 10, 2020. RESULTS: 128 critically ill adult subjects were included in the study (median age 68 y [interquartile range 61-76], 45% female, and 64% Black); 124 (97%) required intubation. Eighty (63%) subjects died during their in-patient stay, which did not differ by race/ethnicity. Compared with other racial/ethnic groups, Blacks had a greater proportion of women (52% vs 30%, P 5 .02) and subjects with hypertension (91% vs 78%, P 5 .035). Asthma (P 5 .03) was associated with lower inpatient death, primarily among Black subjects (P 5 .02). Among Black subjects, increased age (odds ratio 1.06 [95% CI 1.05-1.22] per year), positive fluid balance (odds ratio 1.06 [95% CI 1.01-1.11] per 100 mL), and treatment with tocilizumab (odds ratio 25.0 [95% CI 3.5-180]) were independently associated with in-patient death, while higher platelets (odds ratio 0.65 [95% CI 0.47-0.89] per 50 3 10 3 /mL) and treatment with intermediate dose anticoagulants (odds ratio 0.08 [95% CI 0.02-0.43]) were protective. Among other race/ethnic groups, higher total bilirubin (odds ratio 1.75 [95% CI 0.94-3.25] per 0.2 mg/dL) and higher maximum lactate (odds ratio 1.43 [95% CI 0.96-2.13] per mmol/L) were marginally associated with increased death, while tocilizumab treatment was marginally protective (odds ratio 0.24 [95% CI 0.05-1.25]). During first 72 h of ventilation, those who died had less increase in P aO 2 =F IO 2 (P 5 .046) and less reduction in PEEP (P 5 .01) and F IO 2 requirement (P 5 .002); these patterns did not differ by race/ethnicity. CONCLUSIONS: Black and other race/ethnicity subjects had similar mortality rates due to COVID-19 but differed in factors that were associated with increased risk of death. In both groups, subjects who died were older, had a positive fluid balance, and less improvement in P aO 2 =F IO 2 , PEEP, and F IO 2 requirement on ventilation.

Characteristics, outcomes and global trends of respiratory support in patients hospitalized with COVID-19 pneumonia: a scoping review

“…Thirty studies 7,19,24,25,27,[29][30][31][32][33]35,37,41,43,45,[48][49][50][51]53,59,60,62,63,[65][66][67][68][69]71,72 (58%) reported data on PaO2/FiO2. The median PaO2/FiO2 at admission ranged from 60 mmHg 44 to 442 mmHg 32 .…”

“…Excluding patients from the study by Ranzani et al, the proportion of patients treated with any support was 52%, and, of those, NIV and CPAP were comparably applied in 13.5% and 14.5% of patients, respectively. CPAP was administered in 11 studies (21.1%), and delivered generally by helmet 19,25,27,30,31,33,35,53 (8 studies, 72.7%), while in the remaining three studies the interface used was not reported 32,67,68 . In the study by Bellani et al 27 , the Authors report using the helmet CPAP in 68% of patients, while Vaschetto and colleagues 35 applied CPAP by helmet in 74%, by oro-nasal masks in 23% and by helmet/mask alternation in 3% of patients.…”

“…In the study by Bellani et al 27 , the Authors report using the helmet CPAP in 68% of patients, while Vaschetto and colleagues 35 applied CPAP by helmet in 74%, by oro-nasal masks in 23% and by helmet/mask alternation in 3% of patients. The PEEP used for CPAP, NIV or IMV was reported only in 11 studies 19,24,25,27,33,37,39,[67][68][69]71 (Supplementary Digital Material 1: Supplementary Table 2), and the median value during CPAP/NIV application ranged from 5 cmH2O in the study by Coppadoro et al 33 to 16 (15)(16)(17)(18) cmH2O in the study by Balbi et al 68 .…”

“…Length of stay was available for 30 studies 19,25,26,28,[38][39][40][43][44][45][46][47]49,50,[52][53][54][55]57,59,[61][62][63][64][65]67,68,[70][71][72] (57.7%). The mean duration of the hospital stay was of 13 days, ranging from a minimum of 6 days (IQR 3-14) 55 to a maximum of 63 days (IQR, 8-67) 68 (Supplementary Digital Material 1: Supplementary Figure 4).…”

“…The overall trend of IMV-related mortality is shown in Figure 4, and ranged from 4% in two cases 31,62 to ≥50% in 25/51 studies. 7,23,29,30,34,36,38,40,42,[46][47][48]50,[52][53][54][56][57][58][59]61,[65][66][67]70 Mortality during non invasive respiratory support Mortality in patients treated with CPAP was reported in 8/11 studies (73%), while mortality on NIV was available in 13/38 (34%) of studies. Cumulative mortality on CPAP was 24.8%, while on NIV was 29.1%.…”