What changed between the peak and plateau periods of the first COVID-19 pandemic wave? A multicentric Portuguese cohort study in intensive care.

Autor:	Pereira RA; Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal., Sousa M; Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal., Cidade JP; Hospital São Francisco Xavier, Centro Hospitalar Universitário Lisboa Ocidental - Lisboa, Portugal., Melo L; Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal., Lopes D; Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal., Ventura S; Hospital de São José, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal., Aragão I; Hospital de Santo António, Centro Hospitalar do Porto - Porto, Portugal., Lima Neto RMF; Hospital Vila Nova de Gaia-Espinho - Vila Nova de Gaia, Portugal., Molinos E; Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos - Matosinhos, Portugal., Marques A; Centro Hospitalar Universitário de Coimbra - Coimbra, Portugal., Cardoso N; Hospital Espírito Santo de Évora - Évora, Portugal., Marino F; Hospital de Vila Franca de Xira - Vila Franca de Xira, Portugal., Monteiro FB; Hospital de Egas Moniz, Centro Hospitalar Universitário Lisboa Oriental - Lisboa, Portugal., Oliveira AP; Centro Hospitalar de Tondela-Viseu - Tondela e Viseu, Portugal., Silva RC; Hospital de Santa Luzia, Unidade Local de Saúde Alto Minho - Viana do Castelo, Portugal., Real AMN; Hospital de Abrantes, Centro Hospitalar do Médio Tejo - Abrantes, Portugal., Banheiro BS; Hospital de Portimão, Centro Hospitalar Universitário do Algarve - Portimão, Portugal., Reis R; Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal., Adão-Serrano M; Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal., Cracium A; Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal., Valadas A; Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal., Ribeiro JM; Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal., Póvoa P; Hospital São Francisco Xavier, Centro Hospitalar Universitário Lisboa Ocidental - Lisboa, Portugal., Tapadinhas C; Hospital São Francisco Xavier, Centro Hospitalar Universitário Lisboa Ocidental - Lisboa, Portugal., Mendes V; Hospital São Francisco Xavier, Centro Hospitalar Universitário Lisboa Ocidental - Lisboa, Portugal., Coelho L; Hospital São Francisco Xavier, Centro Hospitalar Universitário Lisboa Ocidental - Lisboa, Portugal., Maia R; Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal., Freitas PT; Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal., Ferreira IA; Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal., Ramires T; Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal., Val-Flores LS; Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal., Cascão M; Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal., Alves R; Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal., Rodeia SC; Hospital de São José, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal., Barrigoto C; Hospital de São José, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal., Cardiga R; Hospital de São José, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal., Silva MJFD; Hospital de Santo António, Centro Hospitalar do Porto - Porto, Portugal., Vale B; Hospital de Santo António, Centro Hospitalar do Porto - Porto, Portugal., Fonseca T; Hospital Vila Nova de Gaia-Espinho - Vila Nova de Gaia, Portugal., Rios AL; Hospital Vila Nova de Gaia-Espinho - Vila Nova de Gaia, Portugal., Camões J; Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos - Matosinhos, Portugal., Pérez D; Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos - Matosinhos, Portugal., Cabral S; Centro Hospitalar Universitário de Coimbra - Coimbra, Portugal., Ribeiro MI; Hospital Espírito Santo de Évora - Évora, Portugal., Mendes JJ; Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal.; Sociedade Portuguesa de Cuidados Intensivos - Lisboa, Portugal., Gouveia J; Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal.; Sociedade Portuguesa de Cuidados Intensivos - Lisboa, Portugal., Fernandes SM; Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal.
Jazyk:	English; Portuguese
Zdroj:	Revista Brasileira de terapia intensiva [Rev Bras Ter Intensiva] 2022 Oct-Dec; Vol. 34 (4), pp. 433-442. Date of Electronic Publication: 2023 Mar 03.
DOI:	10.5935/0103-507X.20210037-pt
Abstrakt:	Objective: To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. Methods: This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. Results: Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39; p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136; p = 0.6), antibiotic therapy (57% versus 64%; p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%; p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5]; p = 0.002) and presented a higher use of vasopressors (47% versus 36%; p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%; p < 0.001) at admission, prone positioning (45% versus 36%; p = 0.04), and hydroxychloroquine (59% versus 10%; p < 0.001) and lopinavir/ritonavir (41% versus 10%; p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%; p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. Conclusion: There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave.
Databáze:	MEDLINE
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