Comparison of clinical course and outcomes of critically ill patients with SARS-CoV2 infection managed in traditional ICU and “Flex” ICU during the surge of the pandemic in the Bronx

Abstract

BACKGROUND: As part of the response to increasing critical care capacity during the unprecedented surge of COVID-19 infections, NYC Health + Hospital systems identified and resourced areas in the hospital that could deliver critical care as "Flex" ICUs to complement the traditional ICUs to manage the rapid influx of critically ill patients. OBJECTIVE: Comparison of clinical features and outcomes of mechanically ventilated COVID-19 patients admitted to the traditional and "Flex" ICUs during the surge of the pandemic. METHODS: Retrospective comparative cohort study of patients with confirmed SARS-CoV-2 infection on mechanical ventilation admitted to traditional ICU and 'Flex' ICU. Univariate and multivariate analyses were conducted to detect factors associated with death from COVID-19 patients in mechanical ventilation by the Cox proportional hazards regression model. RESULTS: Out of the 312 patients on mechanical ventilation, 111(35.6%) were admitted to the traditional ICU, and 201(64.4%) to the 'Flex' ICU. The mortality rate was higher in the 'Flex' ICU compared with the traditional ICU (H.R., 1.37, 95% CI, 1.05-1.81, p<0.05), but the adjusted risk model was not significantly associated with increased mortality (adjusted, H.R., 1.29, 95% CI, 0.97-1.71, p=0.078). CONCLUSION "Flex" ICUs played a crucial role in critically ill patients' management during the pandemic. The mortality risk of patients in the "Flex" ICU was comparable to traditional ICUs in the adjusted analysis. While there is enough evidence for Intensivist managed ICUs to have better outcomes, our study demonstrates the feasibility of non-intensivist leading "Flex" ICUs during a crisis.