The association of the COVID-19 pandemic and short-term outcomes of non-COVID-19 critically ill patients: an observational cohort study in Brazilian ICUs

Zampieri, Fernando G.; Bastos, Leonardo S. L.; Soares, Márcio; Salluh, Jorge I.; Bozza, Fernando A.

doi:10.1007/s00134-021-06528-6

Cited by 33 publications

(29 citation statements)

References 24 publications

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“…We did not study the mortality of patients aged 80 years and older admitted to the ICU for non-COVID causes during the COVIP inclusion period. As documented in Brazil, we cannot exclude there also being a higher mortality for non-COVID patients during the COVID-19 period [ 38 ]…”

Section: Discussionmentioning

confidence: 99%

Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19

Guidet

Jung²,

Flaatten³

et al. 2022

Intensive Care Med

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Purpose The number of patients ≥ 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without COVID-19 with a focus on LLST. Methods Patients 80 years or older with acute respiratory failure were recruited from the VIP2 and COVIP studies. Baseline patient characteristics, interventions in intensive care unit (ICU) and outcomes (30-day survival) were recorded. COVID patients were matched to non-COVID patients based on the following factors: age (± 2 years), Sequential Organ Failure Assessment (SOFA) score (± 2 points), clinical frailty scale (± 1 point), gender and region on a 1:2 ratio. Specific ICU procedures and LLST were compared between the cohorts by means of cumulative incidence curves taking into account the competing risk of discharge and death. Results 693 COVID patients were compared to 1393 non-COVID patients. COVID patients were younger, less frail, less severely ill with lower SOFA score, but were treated more often with invasive mechanical ventilation (MV) and had a lower 30-day survival. 404 COVID patients could be matched to 666 non-COVID patients. For COVID patients, withholding and withdrawing of LST were more frequent than for non-COVID and the 30-day survival was almost half compared to non-COVID patients. Conclusion Very old COVID patients have a different trajectory than non-COVID patients. Whether this finding is due to a decision policy with more active treatment limitation or to an inherent higher risk of death due to COVID-19 is unclear. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06642-z.

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Section: Discussionmentioning

confidence: 99%

Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19

Guidet

Jung²,

Flaatten³

et al. 2022

Intensive Care Med

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“…Author details 1 Departments of Medicine and Community Health Sciences, University of Manitoba, 820 Sherbrook Street, Room GF-222, Winnipeg, MB R3A 1R9, Canada. 2 Department of Surgical Oncological and Oral Science (Di.Chir.…”

Section: Supplementary Informationmentioning

confidence: 99%

“…

In this issue of the journal, Zampieri et al set out to evaluate the influence of the coronavirus disease 2019 (COVID-19) pandemic on adult, non-COVID-19 patients admitted to 165 intensive care units (ICUs) in 45 Brazilian hospitals [1]. They used several statistical techniques to compare hospital mortality in the 2020 cohort to 2011-2019 cohorts.

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mentioning

confidence: 99%

Medical dominos: impact of COVID-19 care on the health of the population

Garland

Cortegiani

2021

Intensive Care Med

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In this issue of the journal, Zampieri et al. set out to evaluate the influence of the coronavirus disease 2019 (COVID-19) pandemic on adult, non-COVID-19 patients admitted to 165 intensive care units (ICUs) in 45 Brazilian hospitals [1]. They used several statistical techniques to compare hospital mortality in the 2020 cohort to 2011-2019 cohorts. This historical comparison period accounted for existing temporal trends, to go along with adjustment for severity of acute illness using SAPS 3 predicted mortality. This was a large study including more than 514,000 patients. Trends prior to the 2020 pandemic included a quadrupling of admissions; small, linear declines in median age (from 64 to 61 years) and SAPS 3 scores (from 43 to 41); and a monotonic decline in mortality (from 11 to 5.6%). While the 2020 non-COVID cohort of 68,000 reversed the trend in admissions, total ICU admissions continued to grow due to more than 21,000 critically ill patients with COVID-19. While age and SAPS 3 of the 2020 non-COVID-19 patients continued to decline, their unadjusted mortality rose to 6.4%. In two separate analyses, risk-adjusted mortality in 2020 rose significantly. Adding evidence that it was due to the pandemic was an analysis showing that adjusted mortality of non-COVID-19 patients undulated in parallel with the number of COVID-19 admissions. Secondary analysis indicated that this effect was most marked for those with the highest SAPS scores. While this study used rigorous methology, it has a few limitations. The authors could have strengthened their analyses using additional variables to adjust for case mix differences over time.

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“…High rates of delirium and coma have been observed in critically ill patients with COVID-19 infection [ 21 ]. Concerns have been raised that surges of COVID-19 cases have impacted the care of critically ill patients without COVID-19 disease, potentially worsening outcomes [ 22 ]. Overall, these findings suggest that the impact of early deep sedation on outcome during the COVID-19 pandemic, for patients with and without COVID-19, is incompletely understood.…”

Section: Introductionmentioning

confidence: 99%

A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED study

et al. 2022

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Background Mechanically ventilated patients have experienced greater periods of prolonged deep sedation during the coronavirus disease (COVID-19) pandemic. Multiple studies from the pre-COVID era demonstrate that early deep sedation is associated with worse outcome. Despite this, there is a lack of data on sedation depth and its impact on outcome for mechanically ventilated patients during the COVID-19 pandemic. We sought to characterize the emergency department (ED) and intensive care unit (ICU) sedation practices during the COVID-19 pandemic, and to determine if early deep sedation was associated with worse clinical outcomes. Study design and methods Dual-center, retrospective cohort study conducted over 6 months (March–August, 2020), involving consecutive, mechanically ventilated adults. All sedation-related data during the first 48 h were collected. Deep sedation was defined as Richmond Agitation-Sedation Scale of − 3 to − 5 or Riker Sedation-Agitation Scale of 1–3. To examine impact of early sedation depth on hospital mortality (primary outcome), we used a multivariable logistic regression model. Secondary outcomes included ventilator-, ICU-, and hospital-free days. Results 391 patients were studied, and 283 (72.4%) experienced early deep sedation. Deeply sedated patients received higher cumulative doses of fentanyl, propofol, midazolam, and ketamine when compared to light sedation. Deep sedation patients experienced fewer ventilator-, ICU-, and hospital-free days, and greater mortality (30.4% versus 11.1%) when compared to light sedation (p < 0.01 for all). After adjusting for confounders, early deep sedation remained significantly associated with higher mortality (adjusted OR 3.44; 95% CI 1.65–7.17; p < 0.01). These results were stable in the subgroup of patients with COVID-19. Conclusions The management of sedation for mechanically ventilated patients in the ICU has changed during the COVID pandemic. Early deep sedation is common and independently associated with worse clinical outcomes. A protocol-driven approach to sedation, targeting light sedation as early as possible, should continue to remain the default approach.

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The association of the COVID-19 pandemic and short-term outcomes of non-COVID-19 critically ill patients: an observational cohort study in Brazilian ICUs

Cited by 33 publications

References 24 publications

Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19

Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19

Medical dominos: impact of COVID-19 care on the health of the population

A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED study

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