Impact of <scp>COVID</scp>‐19 on an Australian intensive care unit: lessons learned from South Australia

Nadkarni, Aniket; Alderson, Steven; Collett, Luke W; Maiden, Matthew J; Reddi, Benjamin; Sundararajan, Krishnaswamy

doi:10.1111/imj.14963

Cited by 8 publications

(15 citation statements)

References 4 publications

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“…A study in Michigan of 141 patients found a mortality frequency of 40.4% (57) at 30 days of admission [ 33 ]. In Australia, a study of 18 patients admitted reported death of four (22%) patients in the ICU [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: A prospective multi-center cohort study

et al. 2021

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Background The coronavirus disease (COVID-19) pandemic has severely affected African countries, specifically the countries, such as Libya, that are in constant conflict. Clinical and laboratory information, including mortality and associated risk factors in relation to hospital settings and available resources, about critically ill patients with COVID-19 in Africa is not available. This study aimed to determine the mortality and morbidity of COVID-19 patients in intensive care units (ICU) following 60 days after ICU admission, and explore the factors that influence in‐ICU mortality rate. Methods This is a multicenter prospective observational study among COVID-19 critical care patients in 11 ICUs in Libya from May 29th to December 30th 2020. Basic demographic data, clinical characteristics, laboratory values, admission Sequential Organ Failure Assessment (SOFA) score, quick SOFA, and clinical management were analyzed. Result We included 465 consecutive COVID-19 critically ill patients. The majority (67.1%) of the patients were older than 60 years, with a median (IQR) age of 69 (56.5–75); 240 (51.6%) were male. At 60 days of follow-up, 184 (39.6%) were discharged alive, while 281 (60.4%) died in the intensive care unit. The median (IQR) ICU length of stay was 7 days (4–10) and non-survivors had significantly shorter stay, 6 (3–10) days. The body mass index was 27.9 (24.1–31.6) kg/m2. At admission to the intensive care unit, quick SOFA median (IQR) score was 1 (1–2), whereas total SOFA score was 6 (4–7). In univariate analysis, the following parameters were significantly associated with increased/decreased hazard of mortality: increased age, BMI, white cell count, neutrophils, procalcitonin, cardiac troponin, C-reactive protein, ferritin, fibrinogen, prothrombin, and d-dimer levels were associated with higher risk of mortality. Decreased lymphocytes, and platelet count were associated with higher risk of mortality. Quick SOFA and total SOFA scores increase, emergency intubation, inotrope use, stress myocardiopathy, acute kidney injury, arrythmia, and seizure were associated with higher mortality. Conclusion Our study reported the highest mortality rate (60.4%) among critically ill patients with COVID-19 60 days post-ICU admission. Several factors were found to be predictive of mortality, which may help to identify patients at risk of mortality during the ongoing COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 99%

Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: A prospective multi-center cohort study

et al. 2021

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“…Our findings are supported by previous studies where although the incidence of a pneumothorax was low (0.3%) in admitted COVID-19 patients, this incidence increased up to 23.8% in those requiring MV. In addition to this, the time interval between a pneumothorax diagnosis and admission had been observed to be around 9 to 19.6 days whereas the time between MV initiation and a pneumothorax was noted to be 5.4 days [ 32 , 33 , 34 , 35 ]. Although a COVID-19-related pneumothorax can be a result of COVID-19-induced inflammation and immune dysregulation, our findings suggest an association between the use of invasive mechanical ventilation and a pneumothorax and encourage further studies to be performed to assess this association.…”

Section: Discussionmentioning

confidence: 99%

Examining the Clinical Prognosis of Critically Ill Patients with COVID-19 Admitted to Intensive Care Units: A Nationwide Saudi Study

et al. 2021

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Backgroundand Objectives: COVID-19 is a novel infectious disease caused by a single-stranded RNA coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to conduct a nationwide multicenter study to determine the characteristics and the clinical prognostic outcome of critically ill COVID-19 patients admitted to intensive care units (ICUs). Materials and Methods: This is a nationwide cohort retrospective study conducted in twenty Saudi hospitals. Results: An analysis of 1470 critically ill COVID-19 patients demonstrated that the majority of patients were male with a mean age of 55.9 ± 15.1 years. Most of our patients presented with a shortness of breath (SOB) (81.3%), followed by a fever (73.7%) and a cough (65.1%). Diabetes and hypertension were the most common comorbidities in the study (52.4% and 46.0%, respectively). Multiple complications were observed substantially more among non-survivors. The length and frequency of mechanical ventilation use were significantly greater (83%) in the non-survivors compared with the survivors (31%). The mean Sequential Organ Failure Assessment (SOFA) score was 6 ± 5. The overall mortality rate of the cohort associated with patients that had diabetes, hypertension and ischemic heart disease was 41.8%. Conclusion: Age; a pre-existing medical history of hypertension, diabetes and ischemic heart disease; smoking cigarettes; a BMI ≥ 29; a long mechanical ventilation and ICU stay; the need of ventilatory support; a high SOFA score; fungal co-infections and extracorporeal membrane oxygenation (ECMO) use were key clinical characteristics that predicted a high mortality in our population.

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“…25 Despite small numbers, our ICU mortality figures are higher than reported in other Australian ICU studies. 20,26 Our case fatality rate of 1.8% compares favourably to the Australian wide rate of 3.0%. 2 We hypothesise that the comparatively lower mortality rate seen in this study is reflective of several factors.…”

Section: Covid-19 Clinical Characteristicsmentioning

confidence: 43%

Clinical characteristics and outcomes of COVID‐19 in a low‐prevalence, well resourced setting, Sydney, Australia

Shiel

Miyakis

Tennant

et al. 2021

Internal Medicine Journal

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Background: The Northern Sydney Local Health District was one of the first health regions to be affected by COVID-19 in Australia.Aims: To describe the clinical characteristics, risk factors and outcomes in our lowprevalence Australian population.Methods: This is a retrospective analysis of 517 laboratory-confirmed COVID-19 cases between January and June 2020. Patient information was collected as part of routine care within the COVID-19 Virtual Hospital system. Outcomes examined were death, recovery at 30 days and intensive care unit (ICU) admission. Results:The case fatality rate was 1.8%. Multivariate analysis showed factors independently associated with death, composite outcome of death/ICU admission or incomplete recovery at 30 days were age >80 years and presence of two or more comorbidities. Most cases acquired COVID-19 through international (50.9%) or cruise ship travel (9.1%). Healthcare workers comprised 12.8% of the cohort and represented a disproportionately high percentage of the 'unknown' source group (27.6%). The median incubation period was 5 days (interquartile range 3-8); one patient had an incubation period of 15 days. Hospitalisation was required in 11.8%, ICU admission in 2.1% and ventilation in 1.4%. A Radiographic Assessment of Lung Oedema score on chest X-ray of >10 was independently associated with death. Conclusions:In this low prevalence, well resourced Australian setting, we report an overall low mortality. Factors associated with adverse patient outcomes on multivariate analysis were age greater than 80 and the presence of two or more comorbidities. These data can assist in early risk stratification of COVID-19 patients, and in surge capacity planning for hospitals.

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Impact of COVID‐19 on an Australian intensive care unit: lessons learned from South Australia

Cited by 8 publications

References 4 publications

Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: A prospective multi-center cohort study

Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: A prospective multi-center cohort study

Examining the Clinical Prognosis of Critically Ill Patients with COVID-19 Admitted to Intensive Care Units: A Nationwide Saudi Study

Clinical characteristics and outcomes of COVID‐19 in a low‐prevalence, well resourced setting, Sydney, Australia

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