Structured ICU resource management in a pandemic is associated with favorable outcome in critically ill COVID‑19 patients

Abstract

Summary Introduction On February 25, 2020, the first 2 patients were tested positive for severe acute respiratory syndrome coronavirus‑2 (SARS-CoV-2) in Tyrol, Austria. Rapid measures were taken to ensure adequate intensive care unit (ICU) preparedness for a surge of critically ill coronavirus disease-2019 (COVID-19) patients. Methods This cohort study included all COVID-19 patients admitted to an ICU with confirmed or strongly suspected COVID-19 in the State of Tyrol, Austria. Patients were recorded in the Tyrolean COVID-19 intensive care registry. Date of final follow-up was July 17, 2020. Results A total of 106 critically ill patients with COVID-19 were admitted to 1 of 13 ICUs in Tyrol from March 9 to July 17, 2020. Median age was 64 years (interquartile range, IQR 54–74 years) and the majority of patients were male (76 patients, 71.7%). Median simplified acute physiology score III (SAPS III) was 56 points (IQR 49–64 points). The median duration from appearance of first symptoms to ICU admission was 8 days (IQR 5–11 days). Invasive mechanical ventilation was required in 72 patients (67.9%) and 6 patients (5.6%) required extracorporeal membrane oxygenation treatment. Renal replacement therapy was necessary in 21 patients (19.8%). Median ICU length of stay (LOS) was 18 days (IQR 5–31 days), median hospital LOS was 27 days (IQR 13–49 days). The ICU mortality was 21.7% (23 patients), hospital mortality was 22.6%. There was no significant difference in ICU mortality in patients receiving invasive mechanical ventilation and in those not receiving it (18.1% vs. 29.4%, p = 0.284). As of July 17th, 2020, two patients are still hospitalized, one in an ICU, one on a general ward. Conclusion Critically ill COVID-19 patients in Tyrol showed high severity of disease often requiring complex treatment with increased lengths of ICU and hospital stay. Nevertheless, the mortality was found to be remarkably low, which may be attributed to our adaptive surge response providing sufficient ICU resources.

Neurological outcome and quality of life 3 months after COVID‐19: A prospective observational cohort study

“…A total of 135/145 patients agreed to participate in the neurological follow‐up 3 months after disease onset and were evaluated using a structured neurological assessment between April 2020 and September 2020. Patients who died during the acute phase were not included in this study, and the ICU mortality rate was 19% as reported elsewhere [18]. Importantly, the Tyrolean healthcare system was never overloaded, and all patients received full medical support [18].…”

“…Patients who died during the acute phase were not included in this study, and the ICU mortality rate was 19% as reported elsewhere [18]. Importantly, the Tyrolean healthcare system was never overloaded, and all patients received full medical support [18].…”

Changes in characteristics and outcomes of critically ill COVID-19 patients in Tyrol (Austria) over 1 year

“…Due to numerous influencing factors different cohorts from various areas have demonstrated widely varying mortality rates and characteristics of intensive care unit (ICU) patients. A meta-analysis published in June 2020 found ICU mortality rates ranging from 14–84% [ 3 ], which has shown the importance of observing regional conditions separately in order to have a better understanding of major factors influencing outcome [ 4 ].…”

“…In Tyrol, Austria, comprising 750,000 inhabitants we established the Tyrolean COVID-19 intensive care registry (Tyrol-CoV-ICU-Reg) at the beginning of the first surge of the pandemic in March 2020. Characteristics and outcomes of the first period have previously been published [ 4 ]. Since then, we continued the registry throughout the second period of the COVID-19 crisis.…”

Outcomes and risk factors for death in patients with coronavirus disease-2019 (COVID-19) pneumonia admitted to the intensive care units of an Egyptian University Hospital. A retrospective cohort study

“…As of December 21, around 75 million infections have been documented around the globe with an overall mortality rate of 2.23% [ 1 ]. Although most patients with SARS-CoV-2 infections have been reported to develop mild to moderate symptoms, patients with severe respiratory insufficiency requiring admission to the intensive care unit (ICU) are at a high risk of major morbidity and subsequently have high mortality rates [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] ]. Several cohort studies have reported the characteristics of and outcomes from COVID-19 pneumonia in these critically ill patients [ 2 , 4 , 5 , 11 , 12 , 20 , 23 ].…”