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OBJECTIVES: Colorado issued a month long statewide lockdown on March 26, 2020, during the initial surge of the COVID-19 pandemic. The impact of this mandate on non–COVID-19 ICU admission rates and outcomes is unclear. DESIGN: We performed a retrospective analysis of all medical ICU admissions in the University of Colorado Health System in four predefined periods: 1) prepandemic (2 mo prior to lockdown period 1); 2) mandated lockdown from March 26 to April 26, 2020 (period 2); 3) between surges (period 3); and 4) nonmandated lockdown surge (between November 1, 2020, and March 31, 2021, period 4). SETTING: Nonsurgical ICU admissions at the University of Colorado Health Systems, including 10 hospitals throughout Colorado. SUBJECTS: All ICU admissions in four predefined time periods. MEASUREMENTS AND MAIN RESULTS: We included 13,787 patients who were admitted during the four study periods. The 28-day mortality rates for non–COVID-19 ICU admissions following index ICU admission were 13.6%, 18.0%, 13.5%, and 16.0% across periods 1–4, respectively. However, the increased odds in non–COVID-19 ICU mortality during the mandated lockdown period relative to prepandemic 1 (odds ratio [OR], 1.39; 95% CI, 1.11–1.72; p = 0.0.04) was attenuated and nonsignificant after adjustment for demographics, comorbidities, diagnosis flags, and severity (OR, 1.15; 95% CI, 0.89–1.48; p = 0.27). Similar results were found in time-to-event analyses. The most common diagnosis in each time period was acute respiratory failure (ARF), and we found it to have increased during lockdown (p < 0.001), whereas sepsis admissions increased during and decreased after lockdown (p = 0.004). Admissions for alcohol withdrawal syndrome (AWS) increased during lockdown and 6 months afterwards (p = 0.005). CONCLUSIONS: For non-COVID-19–related ICU admissions, mortality rate was similar before, during, and after Colorado’s month long lockdown after confounder adjustment, including typical ICU admission flags. Primary admission diagnoses shifted throughout the predefined study periods with more admissions for severe critical diagnoses (i.e., ARF, sepsis, AWS) occurring during the mandated lockdown and nonmandated lockdown periods compared with the prepandemic and between surge period. This would suggest that the perceived increase in mortality during the lockdown for non–COVID-19 ICU admissions may be related to a shift inpatient demographics.

Clinical performance status is designed to be a measure of overall health, reflecting a patient’s physiological reserve and ability to tolerate various forms of therapy. Currently, it is measured by a combination of subjective clinician assessment and patient-reported exercise tolerance in the context of daily living activities. In this study, we assess the feasibility of combining objective data sources and patient-generated health data (PGHD) to improve the accuracy of performance status assessment during routine cancer care. Patients undergoing routine chemotherapy for solid tumors, routine chemotherapy for hematologic malignancies, or hematopoietic stem cell transplant (HCT) at one of four sites in a cancer clinical trials cooperative group were consented to a six-week prospective observational clinical trial (NCT02786628). Baseline data acquisition included cardiopulmonary exercise testing (CPET) and a six-minute walk test (6MWT). Weekly PGHD included patient-reported physical function and symptom burden. Continuous data capture included use of a Fitbit Charge HR (sensor). Baseline CPET and 6MWT could only be obtained in 68% of study patients, suggesting low feasibility during routine cancer treatment. In contrast, 84% of patients had usable fitness tracker data, 93% completed baseline patient-reported surveys, and overall, 73% of patients had overlapping sensor and survey data that could be used for modeling. A linear model with repeated measures was constructed to predict the patient-reported physical function. Sensor-derived daily activity, sensor-derived median heart rate, and patient-reported symptom burden emerged as strong predictors of physical function (marginal R2 0.429–0.433, conditional R2 0.816–0.822). Trial Registration: Clinicaltrials.gov Id NCT02786628.

Background: Previous studies have suggested that the use of heated high-flow nasal canula (HHFNC) may reduce intubation rates in severely hypoxemic patients (PaO 2 /FiO 2 <200). Early in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, HHFNC was underutilized due to concern for viral aerosolization. Studies have since shown that HHFNC has a similar aerosolization risk as a standard oxygen mask prompting increased usage of HHFNC in patients with SARS-CoV-2. We sought to determine if the usage of HHFNC reduced the odds of intubation or the number of ventilator days for patients with acute hypoxemic respiratory failure due to SARS-CoV-2 pneumonia (COVID-19). Methods: We conducted a retrospective cohort study utilizing electronic health record data from the University of Colorado Health System. We included all adult patients admitted to intensive care units between February 1st, 2020 and May 3rd, 2020 with a diagnosis of acute hypoxemic respiratory failure and COVID-19. We divided patients into two groups: patients who received HHFNC and patients who did not receive HHFNC. Patient demographics, clinical characteristics and clinical outcomes were compared. Results: A total of 193 patients were included, of which 41 (21.2%) received HHFNC support. Age, sex, ethnicity, BMI, and comorbidities were similar between both groups. CRP was slightly higher and creatinine lower in the HHFNC group. We found that patients who used HHFNC were 76.5% less likely to receive mechanical ventilation (p<0.001). Patients who were supported with HHFNC spent an average of 5.1 more days on mechanical ventilation (p=0.025). The odds of death were estimated to be 39.4% lower for those who used HHFNC after adjusting for confounders (age, sex, BMI, ethnicity, smoking, alcohol use, prone positioning, corticosteroid use and Remdesivir use) however this effect estimate was not statistically significant. Conclusions: We found that patients with COVID-19 who received HHFNC were less likely to be intubated, which is consistent with previously published data. Those who did require intubation remained on mechanical ventilation for a longer duration. Our study did not detect any differences in mortality between the HHFNC group and the non-HHFNC group. These findings suggest HHFNC may be a useful modality for treatment of acute hypoxemic respiratory failure due to SARS-CoV-2 that may reduce the need for mechanical ventilators during local shortages.