Fewer Intubations but Higher Mortality Among Intubated Coronavirus Disease 2019 Patients During the Second Than the First Wave

OBJECTIVES:. Since changes in pharmacological treatments for severely ill patients with coronavirus disease 2019 have been incorporated into clinical practice, both by their use (corticosteroids and remdesivir) and by stopping them (e.g., hydroxychloroquine), we sought to compare the rate of intubat...

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Autores principales:	Christina Routsi, MD, PhD, Stelios Kokkoris, MD, PhD, Ilias Siempos, MD, PhD, Eleni Magira, MD, PhD, Anastasia Kotanidou, MD, PhD, Spyros Zakynthinos, MD, PhD
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer 2021
Materias:	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/d066d43d214444f48716f0bc7f16731f
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spelling	oai:doaj.org-article:d066d43d214444f48716f0bc7f16731f2021-11-25T07:56:43ZFewer Intubations but Higher Mortality Among Intubated Coronavirus Disease 2019 Patients During the Second Than the First Wave2639-802810.1097/CCE.0000000000000531https://doaj.org/article/d066d43d214444f48716f0bc7f16731f2021-10-01T00:00:00Zhttp://journals.lww.com/10.1097/CCE.0000000000000531https://doaj.org/toc/2639-8028OBJECTIVES:. Since changes in pharmacological treatments for severely ill patients with coronavirus disease 2019 have been incorporated into clinical practice, both by their use (corticosteroids and remdesivir) and by stopping them (e.g., hydroxychloroquine), we sought to compare the rate of intubation and mortality of intubated patients in our ICUs between the first and second waves of the pandemic. DESIGN:. Single-center, observational. SETTING:. Four coronavirus disease 2019 designated ICUs at an urban Greek teaching hospital. PATIENTS:. All adult patients with coronavirus disease 2019 consecutively admitted to ICU during the first (n = 50) and second (n = 212) waves of the pandemic. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. The percentage of intubated ICU patients dropped from 82% during the first wave to 66% during the second wave (p = 0.042). However, the absolute number of intubated ICU patients was lower during the first than the second wave (41 vs 140 patients). ICU or hospital mortality of intubated patients increased from 39% during the first wave to 60% during the second wave (p = 0.028). The binary logistic regression for hospital mortality as the dependent variable in intubated patients and covariates the age, Acute Physiology and Chronic Health Evaluation II score, cardiovascular comorbidity, lactate, positive end-expiratory pressure, Sequential Organ Failure Assessment score, and wave, distinguished only Acute Physiology and Chronic Health Evaluation II (odds ratio, 1.40 with 95% CI, 1.14—1.72; p = 0.001) as the sole independent predictor of hospital mortality. CONCLUSIONS:. Pharmacological adaptations and other measures may have led to fewer intubations over time. However, these changes do not seem to be translated into improved outcomes of intubated patients. Perhaps the same change in the use of drugs and protocols that could cause fewer intubations of ICU patients might be a reason of increased mortality in those patients who are eventually intubated. Furthermore, the relative staff inexperience and overall increase in patients’ comorbidities during the second wave could have contributed to increased Acute Physiology and Chronic Health Evaluation II score and mortality of intubated patients.Christina Routsi, MD, PhDStelios Kokkoris, MD, PhDIlias Siempos, MD, PhDEleni Magira, MD, PhDAnastasia Kotanidou, MD, PhDSpyros Zakynthinos, MD, PhDWolters KluwerarticleMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENCritical Care Explorations, Vol 3, Iss 10, p e531 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Christina Routsi, MD, PhD Stelios Kokkoris, MD, PhD Ilias Siempos, MD, PhD Eleni Magira, MD, PhD Anastasia Kotanidou, MD, PhD Spyros Zakynthinos, MD, PhD Fewer Intubations but Higher Mortality Among Intubated Coronavirus Disease 2019 Patients During the Second Than the First Wave
description	OBJECTIVES:. Since changes in pharmacological treatments for severely ill patients with coronavirus disease 2019 have been incorporated into clinical practice, both by their use (corticosteroids and remdesivir) and by stopping them (e.g., hydroxychloroquine), we sought to compare the rate of intubation and mortality of intubated patients in our ICUs between the first and second waves of the pandemic. DESIGN:. Single-center, observational. SETTING:. Four coronavirus disease 2019 designated ICUs at an urban Greek teaching hospital. PATIENTS:. All adult patients with coronavirus disease 2019 consecutively admitted to ICU during the first (n = 50) and second (n = 212) waves of the pandemic. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. The percentage of intubated ICU patients dropped from 82% during the first wave to 66% during the second wave (p = 0.042). However, the absolute number of intubated ICU patients was lower during the first than the second wave (41 vs 140 patients). ICU or hospital mortality of intubated patients increased from 39% during the first wave to 60% during the second wave (p = 0.028). The binary logistic regression for hospital mortality as the dependent variable in intubated patients and covariates the age, Acute Physiology and Chronic Health Evaluation II score, cardiovascular comorbidity, lactate, positive end-expiratory pressure, Sequential Organ Failure Assessment score, and wave, distinguished only Acute Physiology and Chronic Health Evaluation II (odds ratio, 1.40 with 95% CI, 1.14—1.72; p = 0.001) as the sole independent predictor of hospital mortality. CONCLUSIONS:. Pharmacological adaptations and other measures may have led to fewer intubations over time. However, these changes do not seem to be translated into improved outcomes of intubated patients. Perhaps the same change in the use of drugs and protocols that could cause fewer intubations of ICU patients might be a reason of increased mortality in those patients who are eventually intubated. Furthermore, the relative staff inexperience and overall increase in patients’ comorbidities during the second wave could have contributed to increased Acute Physiology and Chronic Health Evaluation II score and mortality of intubated patients.
format	article
author	Christina Routsi, MD, PhD Stelios Kokkoris, MD, PhD Ilias Siempos, MD, PhD Eleni Magira, MD, PhD Anastasia Kotanidou, MD, PhD Spyros Zakynthinos, MD, PhD
author_facet	Christina Routsi, MD, PhD Stelios Kokkoris, MD, PhD Ilias Siempos, MD, PhD Eleni Magira, MD, PhD Anastasia Kotanidou, MD, PhD Spyros Zakynthinos, MD, PhD
author_sort	Christina Routsi, MD, PhD
title	Fewer Intubations but Higher Mortality Among Intubated Coronavirus Disease 2019 Patients During the Second Than the First Wave
title_short	Fewer Intubations but Higher Mortality Among Intubated Coronavirus Disease 2019 Patients During the Second Than the First Wave
title_full	Fewer Intubations but Higher Mortality Among Intubated Coronavirus Disease 2019 Patients During the Second Than the First Wave
title_fullStr	Fewer Intubations but Higher Mortality Among Intubated Coronavirus Disease 2019 Patients During the Second Than the First Wave
title_full_unstemmed	Fewer Intubations but Higher Mortality Among Intubated Coronavirus Disease 2019 Patients During the Second Than the First Wave
title_sort	fewer intubations but higher mortality among intubated coronavirus disease 2019 patients during the second than the first wave
publisher	Wolters Kluwer
publishDate	2021
url	https://doaj.org/article/d066d43d214444f48716f0bc7f16731f
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Fewer Intubations but Higher Mortality Among Intubated Coronavirus Disease 2019 Patients During the Second Than the First Wave

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