Effect of New Treatment Strategies of COVID-19 Intensive Care Unit Patients in the Second Wave and its Impact on Mortality

Abstract

Aims:We analysed the differences in treatment strategies among COVID 19 patients requiring intensive care in the first and second COVID 19 waves and their impact on mortality in our hospital and compared them with the literature. Subjects and Methods: We included in our population all patients admitted to HELIOS Klinikum Krefeld, Germany, with a proven diagnosis of COVID-19 in the first wave (n = 84; from March 11, 2020-June 30, 2020 and the second wave (n= 344; from July 01, 2020-January 31, 2021). In addition, we searched PubMed and Medline for other publications reporting similar data of COVID-19 cases in the first and second waves and their treatment. Finally, we included 5 publications Results: The characteristics of our patients were similar in both waves, but slightly more men were treated in the ICU in the second wave. Despite obvious changes in treatment in the second wave, the mortality rate was higher at 34.7% in the second wave than at 28.6% in the first wave. The mortality rate was higher despite increased use of dexamethasone and remdesivir and a lower proportion of intubated patients. Comparison of the results with the literature shows a nearly linear relationship between increases in dexamethasone treatment and decreases in mortality (R 2 of 0.6509), suggesting that fewer people died with increasing use of dexamethasone. There is no relevant correlation for remdesivir (R 2 of 0.0712). There is also no correlation between the decrease in the number of mechanically ventilated patients and mortality (R 2 of 0.0253). Less mechanical ventilation does not correlate with lower mortality. Conclusion: Only the increased use of dexamethasone correlated with a decrease in mortality in the second wave; the increased use of remdesivir and the reduction in mechanical ventilation did not.