Characteristics and definitive outcomes of COVID‐19 patients admitted to a secondary hospital intensive care unit in Sweden

Abstract

Background and Aims Most published reports of COVID‐19 Intensive Care Unit (ICU) patients are from large tertiary hospitals and often present short‐term or incomplete outcome data. There are reports indicating that ICUs with fewer beds are associated with higher mortality. This study aimed to investigate the definitive outcome and patient characteristics of the complete first wave of COVID‐19 patients admitted to ICU in a secondary hospital. Methods In this prospective observational study, all patients with respiratory failure and a positive SARS‐CoV‐2 test admitted to Västerås Hospital ICU between 24 March and July 22, 2020 were included. The primary outcome was defined as 90‐day mortality. Secondary outcomes included ICU length of stay, hospital length of stay, number of days with invasive ventilation, need for vasopressors/inotropes, and use of renal replacement therapy. Results Fifty‐three patients were included. Median age (range) was 59 (33‐76) and 74% were men. Obesity and hypertension were the most common comorbidities and 45% of the patients were born outside Europe. Ninety‐day mortality was 30%. Median ICU length of stay (interquartile range) was 14 (5‐24) days and the duration of invasive mechanical ventilation 16 (12‐26) days. No patients received dialysis at 90‐day follow‐up. Conclusion In this cohort of COVID‐19 patients treated in a secondary hospital ICU, mortality rates were low compared to early studies from China, Italy, and the United States, but similar to other government‐funded hospitals in Scandinavia. A preparatory reorganization enabled an increase in ICU capacity, hence avoiding an overwhelmed intensive care organization.

Association of vasopressors with mortality in critically ill patients with COVID-19: A systematic review and meta-analysis

“…The studies originated from multiple countries, with 13 of coming from institutions located in the USA [20,21,23,[32][33][34][35]38,42,43,45,48,51]. Nineteen studies included only patients admitted in the ICU [20,22,24,25,27,[30][31][32][35][36][37][38][39][43][44][45][46][47]52], five studies included patients admitted in a COVID-19-dedicated HDU [28,29,33,34,42], eight studies included patients who were admitted in both HDU and ICU [21,23,26,40,41,48,49,51], and one study included Emergency Department patients who were later admitted either in the HDU of ICU [50]. Thirty studies included data about patients who received vs. patients who did not receive vasopressors…”

“…Twenty-one out of the 33 included studies provided data on hospital mortality in patients who received vs. patients who did not receive vasopressors, resulting in a total population of 7900 individuals [25,27,[31][32][33][34][35][36][37][39][40][41][42][43][44][45][46][47][48]50,52]. Due to high heterogeneity (I 2 : 94%, PQ<0.001), the random-effects model was implemented.…”

Dysnatremia and its Clinical Significance in COVID-19 Era

“…However, not all of the patients developed CAP. Cuesta et al couldnot find more than a trend toward greater mortality in hyponatremia in CAP in their prospective research [26]. Differences in findings might be related to differences in the sample size of patients enrolled.…”