Preparedness and Reorganization of Care for Coronavirus Disease 2019 Patients in a Swiss ICU: Characteristics and Outcomes of 129 Patients

Primmaz, Steve; Terrier, Christophe Le; Suh, Noémie; Ventura, François; Boroli, Filippo; Bendjelid, Karim; Cereghetti, Sara; Giraud, Raphaël; Heidegger, Claudia Paula; Pugin, Déborah; Siegenthaler, Nils; Tassaux, Didier; Cabrol, Jean-Clément; Dolet, Nathan; Ellenberger, Christoph; Barcelos, Gleicy Keli; Licker, Marc; Savoldelli, Georges Louis; Schiffer, Eduardo; Gayet-Ageron, Angèle; Kaiser, Laurent; Tramèr, Martin R.; Pugin, Jérôme

doi:10.1097/cce.0000000000000173

Cited by 31 publications

(45 citation statements)

References 34 publications

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“…We used the general term “relative risk” to refer to the mortality risk. A total of 16 observational studies ( Berenguer et al, 2020 ; Cao et al, 2020b ; Catteau et al, 2020 ; Ferrando et al, 2020 ; Gupta et al, 2020 ; Krishnan et al, 2020 ; Lee et al, 2020a ; Morrison et al, 2020 ; Nowak et al, 2020 ; Okoh et al, 2020 ; Primmaz et al, 2020 ; Salacup et al, 2020 ; Wang et al, 2020a ; Yan et al, 2020b ; Zerah et al, 2020 ; Zhou et al, 2020 ) were involved in this assessment. We extracted the number of patients who died from COVID-19 following a certain treatment.…”

Section: Resultsmentioning

confidence: 99%

Evaluation of the Current Therapeutic Approaches for COVID-19: A Systematic Review and a Meta-analysis

et al. 2021

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Background: Limited data on the efficacy and safety of currently applied COVID-19 therapeutics and their impact on COVID-19 outcomes have raised additional concern.Objective and Methods: To estimate the efficacy and safety of COVID-19 therapeutics, we performed meta-analyses of the studies reporting clinical features and treatments of COVID-19 published from January 21 to September 6, 2020.Results: We included 136 studies that involved 102,345 COVID-19 patients. The most prevalent treatments were antibiotics (proportion: 0.59, 95% CI: [0.51, 0.67]) and antivirals (proportion: 0.52, 95% CI: [0.44, 0.60]). The combination of lopinavir/ritonavir and Arbidol was the most effective in treating COVID-19 (standardized mean difference (SMD) = 0.68, 95% CI: [0.15, 1.21]). The use of corticosteroids was associated with a small clinical improvement (SMD = −0.40, 95% CI: [−0.85, −0.23]), but with a higher risk of disease progression and death (mortality: RR = 9.26, 95% CI: [4.81, 17.80]; hospitalization length: RR = 1.54, 95% CI: [1.39, 1.72]; severe adverse events: RR = 2.65, 95% CI: [2.09, 3.37]). The use of hydroxychloroquine was associated with a higher risk of death (RR = 1.68, 95% CI: [1.18, 2.38]). The combination of lopinavir/ritonavir, ribavirin, and interferon-β (RR = 0.34, 95% CI: [0.22, 0.54]); hydroxychloroquine (RR = 0.58, 95% CI: [0.39, 0.58]); and lopinavir/ritonavir (RR = 0.72, 95% CI: [0.56, 0.91]) was associated with reduced hospitalization length. Hydrocortisone (RR = 0.05, 95% CI: [0.03, 0.10]) and remdesivir (RR = 0.74, 95% CI: [0.62, 0.90]) were associated with lower incidence of severe adverse events. Dexamethasone was not significant in reducing disease progression (RR = 0.45, 95% CI: [0.16, 1.25]) and mortality (RR = 0.90, 95% CI: [0.70, 1.16]). The estimated combination of corticosteroids with antivirals was associated with a better clinical improvement than antivirals alone (SMD = −1.09, 95% CI: [−1.64, −0.53]).Conclusion: Antivirals are safe and effective in COVID-19 treatment. Remdesivir cannot significantly reduce COVID-19 mortality and hospitalization length, while it is associated with a lower incidence of severe adverse events. Corticosteroids could increase COVID-19 severity, but it could be beneficial when combined with antivirals. Our data are potentially valuable for the clinical treatment and management of COVID-19 patients.

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Section: Resultsmentioning

confidence: 99%

Evaluation of the Current Therapeutic Approaches for COVID-19: A Systematic Review and a Meta-analysis

et al. 2021

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“…In a Spanish study [ 26 ], of 960 critically ill patients had a SOFA score of 5 (3–7), and the overall mortality rate was 31% (203 out of 960). In a Swiss single-center prospective study of 129 patients, the SOFA score was 6 (4–7); however, the mortality rate was 19% (24 out of 129) [ 38 ]. Another multicenter study conducted in Germany found a SOFA score of 5 (3–9), with a mortality rate of 35% (78 out of 223) [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: A prospective multi-center cohort study

et al. 2021

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Background The coronavirus disease (COVID-19) pandemic has severely affected African countries, specifically the countries, such as Libya, that are in constant conflict. Clinical and laboratory information, including mortality and associated risk factors in relation to hospital settings and available resources, about critically ill patients with COVID-19 in Africa is not available. This study aimed to determine the mortality and morbidity of COVID-19 patients in intensive care units (ICU) following 60 days after ICU admission, and explore the factors that influence in‐ICU mortality rate. Methods This is a multicenter prospective observational study among COVID-19 critical care patients in 11 ICUs in Libya from May 29th to December 30th 2020. Basic demographic data, clinical characteristics, laboratory values, admission Sequential Organ Failure Assessment (SOFA) score, quick SOFA, and clinical management were analyzed. Result We included 465 consecutive COVID-19 critically ill patients. The majority (67.1%) of the patients were older than 60 years, with a median (IQR) age of 69 (56.5–75); 240 (51.6%) were male. At 60 days of follow-up, 184 (39.6%) were discharged alive, while 281 (60.4%) died in the intensive care unit. The median (IQR) ICU length of stay was 7 days (4–10) and non-survivors had significantly shorter stay, 6 (3–10) days. The body mass index was 27.9 (24.1–31.6) kg/m2. At admission to the intensive care unit, quick SOFA median (IQR) score was 1 (1–2), whereas total SOFA score was 6 (4–7). In univariate analysis, the following parameters were significantly associated with increased/decreased hazard of mortality: increased age, BMI, white cell count, neutrophils, procalcitonin, cardiac troponin, C-reactive protein, ferritin, fibrinogen, prothrombin, and d-dimer levels were associated with higher risk of mortality. Decreased lymphocytes, and platelet count were associated with higher risk of mortality. Quick SOFA and total SOFA scores increase, emergency intubation, inotrope use, stress myocardiopathy, acute kidney injury, arrythmia, and seizure were associated with higher mortality. Conclusion Our study reported the highest mortality rate (60.4%) among critically ill patients with COVID-19 60 days post-ICU admission. Several factors were found to be predictive of mortality, which may help to identify patients at risk of mortality during the ongoing COVID-19 pandemic.

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“…Johns Hopkins Hospital described in detail how they turned half of their PICU into an adult MICU ( 2 ). Other facilities have described transformation of step-down units, postanesthesia care units, and operating suites into temporary ICUs to meet the expanded needs of the COVID-19 population ( 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…Primmaz et al ( 1 ) determined earlier this year that with appropriate preparation, rapid adaptive ICU reorganization for patients with severe COVID-19 maintained good quality of care and a resulting low mortality rate. The purpose of this study is to determine if ICU reorganization due to COVID-19 pandemic affected outcomes of critically ill patients who were “not” infected with COVID-19.…”

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confidence: 99%

The Effects of ICU Crisis Reorganization on Outcomes in Patients Not Infected With Coronavirus Disease 2019 During the Initial Surge of the Coronavirus Disease 2019 Pandemic

Rana

Hughes

Rana

et al. 2021

Critical Care Explorations

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Objectives: To determine if ICU reorganization due to the coronavirus disease 2019 pandemic affected outcomes in critically ill patients who were not infected with coronavirus disease 2019. Design: This was a Before-After study, with coronavirus disease 2019-induced ICU reorganization as the intervention. A retrospective chart review of adult patients admitted to a reorganized ICU during the coronavirus disease 2019 surge (from March 23, 2020, to May 06, 2020: intervention group) was compared with patients admitted to the ICU prior to coronavirus disease 2019 surge (from January 10, 2020, to February 23, 2020: before group). Setting: High-intensity cardiac, medical, and surgical ICUs of a community hospital in metropolitan Missouri. PATIENTS: All patients admitted to the ICU during the before and intervention period were included. Patients younger than 18 years old and those admitted after an elective procedure or surgery were excluded. Patients with coronavirus disease 2019 were excluded. Interventions: None. Measurements and Main Results: We identified a total of 524 eligible patients: 342 patients in the before group and 182 in the intervention group. The 28-day mortality was 25.1% (86/342) and 28.6% (52/182), respectively (p = 0.40). The ICU length of stay, ventilator length of stay, and ventilator-free days were similar in both groups. Rates of patient adverse events including falls, inadvertent endotracheal tube removal, reintubation within 48 hours of extubation, and hospital acquired pressure ulcers occurred more frequently in the study group (20 events, 11%) versus control group (12 events, 3.5%) (p = 0.001). Conclusions: Twenty-eight-day mortality, in patients who required ICU care and were not infected with coronavirus disease 2019, was not significantly affected by ICU reorganization during a pandemic.

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Preparedness and Reorganization of Care for Coronavirus Disease 2019 Patients in a Swiss ICU: Characteristics and Outcomes of 129 Patients

Abstract: Supplemental Digital Content is available in the text.

Cited by 31 publications

References 34 publications

Evaluation of the Current Therapeutic Approaches for COVID-19: A Systematic Review and a Meta-analysis

Evaluation of the Current Therapeutic Approaches for COVID-19: A Systematic Review and a Meta-analysis

Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: A prospective multi-center cohort study

The Effects of ICU Crisis Reorganization on Outcomes in Patients Not Infected With Coronavirus Disease 2019 During the Initial Surge of the Coronavirus Disease 2019 Pandemic

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