Intensive Care Resources and 60-Day Survival of Critically-Ill COVID-19 Patients

Abstract

Background: Germany reported sufficient intensive care unit (ICU) resources throughout the first wave of coronavirus disease 2019 (COVID-19). The treatment of critically ill COVID-19 patients without rationing may improve the outcome. We therefore analyzed ICU resources allocated to COVID-19 patients with respiratory failure and their outcomes. Methods: Retrospectively, we enrolled severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR)-positive patients with respiratory failure from 03/08/2020 to 04/08/2020 and followed until 05/28/2020 in the university hospital of Freiburg, Germany. Results: In the defined interval, 34 COVID-19 patients were admitted to the ICU with median age of 67±13 (31-86) years. Six of 34 (17.6%) were female. All patients suffered from moderate or severe acute respiratory distress syndrome (ARDS), 91.2% of the patients were intubated and 23.5% required extracorporeal membrane oxygenation (ECMO). Proning was performed in 67.6%, renal replacement therapy (RRT) was required in 35.3%. Ninety-six percent required more than 20 nursing hours per day. Mean ICU stay was 21±19 (1-81) days. Sixty-day survival of critically ill COVID-19 patients was 50.0% (17/34). Causes of death were multi-organ failure (52.9%), refractory ARDS (17.6%) and intracerebral hemorrhage (17.6%). Conclusions: Treatment of critically ill COVID-19 patients is protracted and resource-intense. In a context without resources shortage, 50% of COVID-19 with respiratory failure survived up to 60 days.

Clinical Characteristics of Invasively Ventilated Covid-19 Patients: An Overview of Clinical Experience in Pauls Stradiņš Clinical University Hospital, Rīga, Latvia

“…Accordingly, this would mean that prone positioning was applied to patients with worse disease severity, explaining the clinical outcomes for patients in the PP group. Nevertheless, there was a statistically significant improvement of oxygenation in prone positioning (p < 0.001), as previously observed (Langer et al, 2021;Lang et al, 2021). cific treatment was recommended for coronavirus infection, except for scrupulous symptomatic and supportive treatment.…”

“…The prevalence of such comorbidities as hypertension and diabetes was slightly higher in the population of our study, reaching 63.6% and 36%, respectively (Di Lecce et al, 2020;Immovilli, 2020;Lang et al, 2021;Zanella et al, 2021).…”

“…The clinical spectrum of SARS-CoV-2 ranges from asymptomatic or mild cases to a critical disease with acute respiratory failure. Previous reports Hong et al, 2020;Immovilli, 2020;Langer et al, 2021) showed that, on average, one quarter of patients hospitalised with COVID-19 required admission to an intensive care unit and at least half of them required invasive mechanical ventilation (IMV) (Di Lecce et al, 2020;Lang et al, 2021). Baseline characteristics reported for most ICU patients were obesity, diabetes, hypertension, and cardiovascular disease (Hajjar et al, 2021).…”

“…Baseline characteristics reported for most ICU patients were obesity, diabetes, hypertension, and cardiovascular disease (Hajjar et al, 2021). The overall ICU mortality varied widely: from 16% to 88%, depending on patient and healthcare system characteristics, with an invariably higher mortality rate in the invasively ventilated patient group Huang et al, 2020;Wei-jie, 2020;Lang et al, 2021;Zanella et al, 2021).…”

Respiratory system mechanics, gas exchange, and outcomes in mechanically ventilated patients with COVID-19-related acute respiratory distress syndrome: a systematic review and meta-analysis

“…Increasing severity of COVID-19-related ARDS, assessed by PaO 2 /FiO 2 , was associated with reduced C RS (p interaction <0·0001): C RS progressively decreased from 39·3 mL/cm H 2 O (95% CI 36·6–42·0) in patients with mild ARDS, to 34·9 mL/cm H 2 O (32·8–36·9) in patients with moderate ARDS, and 27·3 mL/cm H 2 O (23·3–31·2) in patients with severe ARDS ( table 1 , figure 4 ). 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 There was no significant association between C RS and PaCO 2 (31·5 [95% CI 27·7–35·4] in patients with PaCO 2 >45 mm Hg vs 36·5 [33·3–39·6] in those with PaCO 2 ≤45 mm Hg; p interaction =0·052; table 1 ) or between C RS and PEEP (35·2 [95% CI 27·6–42·8] in patients with PEEP >15 cm H 2 O vs 34·2 [32·3–36·2] in those with PEEP ≤15 cm H 2 O; p interaction =0·80; table 1 ). Further details of the association between C RS and PEEP are provided in the appendix (pp 8–9 ).…”