Critically Ill Adults With Coronavirus Disease 2019 in New Orleans and Care With an Evidence-Based Protocol
| Autor: | Nicholas Sausen, Anushka Das, Lauren Auerbach, Robin McGoey, David Feinswog, Scott Mackey, Michelle St. Romain, Jennifer Schwehm, Ryan Chan, Joseph Grace, Angellica O. Gordon, Jordan Vaughn, Beau P. Saccoccia, David R. Janz, Marian Sackey, Lana Phan, Stephen P. Kantrow, Bethany Busack, Hayoung Lee, Nirav Patel, Kyle I. Happel |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Mechanical ventilation
Pulmonary and Respiratory Medicine medicine.medical_specialty Evidence-based practice Coronavirus disease 2019 (COVID-19) business.industry Critically ill medicine.medical_treatment Mortality rate Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine 030228 respiratory system Interquartile range Cohort Emergency medicine medicine 030212 general & internal medicine business Cardiology and Cardiovascular Medicine Cohort study |
| Zdroj: | Chest |
| ISSN: | 0012-3692 |
| DOI: | 10.1016/j.chest.2020.08.2114 |
| Popis: | Background Characteristics of critically ill adults with coronavirus disease 2019 (COVID-19) in an academic safety net hospital and the effect of evidence-based practices in these patients are unknown. Research Question What are the outcomes of critically ill adults with COVID-19 admitted to a network of hospitals in New Orleans, Louisiana, and what is an evidence-based protocol for care associated with improved outcomes? Study Design and Methods In this multi-center, retrospective, observational cohort study of ICUs in four hospitals in New Orleans, Louisiana, we collected data on adults admitted to an ICU and tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 9, 2020 and April 14, 2020. The exposure of interest was admission to an ICU that implemented an evidence-based protocol for COVID-19 care. The primary outcome was ventilator-free days. Results The initial 147 patients admitted to any ICU and tested positive for SARS-CoV-2 constituted the cohort for this study. In the entire network, exposure to an evidence-based protocol was associated with more ventilator-free days (25 days; 0-28) compared with non-protocolized ICUs (0 days; 0-23, P = .005), including in adjusted analyses (P = .02). Twenty patients (37%) admitted to protocolized ICUs died compared with 51 (56%; P = .02) in non-protocolized ICUs. Among 82 patients admitted to the academic safety net hospital's ICUs, the median number of ventilator-free days was 22 (interquartile range, 0-27) and mortality rate was 39%. Interpretation Care of critically ill COVID-19 patients with an evidence-based protocol is associated with increased time alive and free of invasive mechanical ventilation. In-hospital survival occurred in most critically ill adults with COVID-19 admitted to an academic safety net hospital's ICUs despite a high rate of comorbidities. |
| Databáze: | OpenAIRE |
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