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Wendel-Garcia, Pedro David; Moser, André; Jeitziner, Marie-Madlen; Aguirre-Bermeo, Hernán; Arias-Sanchez, Pedro; Apolo, Janina; Roche-Campo, Ferran; Franch-Llasat, Diego; Kleger, Gian-Reto; Schrag, Claudia; Pietsch, Urs; Filipovic, Miodrag; David, Sascha; Stahl, Klaus; Bouaoud, Souad; Ouyahia, Amel; Fodor, Patricia; Locher, Pascal; Siegemund, Martin; Zellweger, Nuria; Cereghetti, Sara; Schott, Peter; Gangitano, Gianfilippo; Wu, Maddalena Alessandra; [...]

Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry

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  • Media type: E-Article
  • Title: Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry
  • Contributor: Wendel-Garcia, Pedro David; Moser, André; Jeitziner, Marie-Madlen; Aguirre-Bermeo, Hernán; Arias-Sanchez, Pedro; Apolo, Janina; Roche-Campo, Ferran; Franch-Llasat, Diego; Kleger, Gian-Reto; Schrag, Claudia; Pietsch, Urs; Filipovic, Miodrag; David, Sascha; Stahl, Klaus; Bouaoud, Souad; Ouyahia, Amel; Fodor, Patricia; Locher, Pascal; Siegemund, Martin; Zellweger, Nuria; Cereghetti, Sara; Schott, Peter; Gangitano, Gianfilippo; Wu, Maddalena Alessandra; [...]
  • imprint: Springer Science and Business Media LLC, 2022
  • Published in: Critical Care
  • Language: English
  • DOI: 10.1186/s13054-022-04065-2
  • ISSN: 1364-8535
  • Origination:
  • Footnote:
  • Description: <jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>It remains elusive how the characteristics, the course of disease, the clinical management and the outcomes of critically ill COVID-19 patients admitted to intensive care units (ICU) worldwide have changed over the course of the pandemic.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Prospective, observational registry constituted by 90 ICUs across 22 countries worldwide including patients with a laboratory-confirmed, critical presentation of COVID-19 requiring advanced organ support. Hierarchical, generalized linear mixed-effect models accounting for hospital and country variability were employed to analyse the continuous evolution of the studied variables over the pandemic.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Four thousand forty-one patients were included from March 2020 to September 2021. Over this period, the age of the admitted patients (62 [95% CI 60–63] years vs 64 [62–66] years,<jats:italic>p</jats:italic> &lt; 0.001) and the severity of organ dysfunction at ICU admission decreased (Sequential Organ Failure Assessment 8.2 [7.6–9.0] vs 5.8 [5.3–6.4],<jats:italic>p</jats:italic> &lt; 0.001) and increased, while more female patients (26 [23–29]% vs 41 [35–48]%,<jats:italic>p</jats:italic> &lt; 0.001) were admitted. The time span between symptom onset and hospitalization as well as ICU admission became longer later in the pandemic (6.7 [6.2–7.2| days vs 9.7 [8.9–10.5] days,<jats:italic>p</jats:italic> &lt; 0.001). The PaO<jats:sub>2</jats:sub>/FiO<jats:sub>2</jats:sub>at admission was lower (132 [123–141] mmHg vs 101 [91–113] mmHg,<jats:italic>p</jats:italic> &lt; 0.001) but showed faster improvements over the initial 5 days of ICU stay in late 2021 compared to early 2020 (34 [20–48] mmHg vs 70 [41–100] mmHg,<jats:italic>p</jats:italic> = 0.05). The number of patients treated with steroids and tocilizumab increased, while the use of therapeutic anticoagulation presented an inverse U-shaped behaviour over the course of the pandemic. The proportion of patients treated with high-flow oxygen (5 [4–7]% vs 20 [14–29],<jats:italic>p</jats:italic> &lt; 0.001) and non-invasive mechanical ventilation (14 [11–18]% vs 24 [17–33]%,<jats:italic>p</jats:italic> &lt; 0.001) throughout the pandemic increased concomitant to a decrease in invasive mechanical ventilation (82 [76–86]% vs 74 [64–82]%,<jats:italic>p</jats:italic> &lt; 0.001). The ICU mortality (23 [19–26]% vs 17 [12–25]%,<jats:italic>p</jats:italic> &lt; 0.001) and length of stay (14 [13–16] days vs 11 [10–13] days,<jats:italic>p</jats:italic> &lt; 0.001) decreased over 19 months of the pandemic.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Characteristics and disease course of critically ill COVID-19 patients have continuously evolved, concomitant to the clinical management, throughout the pandemic leading to a younger, less severely ill ICU population with distinctly different clinical, pulmonary and inflammatory presentations than at the onset of the pandemic.</jats:p></jats:sec>
  • Access State: Open Access