Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry

Wendel-Garcia, Pedro David and Moser, André and Jeitziner, Marie-Madlen and Aguirre-Bermeo, Hernán and Arias-Sanchez, Pedro and Apolo, Janina and Roche-Campo, Ferran and Franch-Llasat, Diego and Kleger, Gian-Reto and Schrag, Claudia and Pietsch, Urs and Filipovic, Miodrag and David, Sascha and Stahl, Klaus and Bouaoud, Souad and Ouyahia, Amel and Fodor, Patricia and Locher, Pascal and Siegemund, Martin and Zellweger, Nuria and Cereghetti, Sara and Schott, Peter and Gangitano, Gianfilippo and Wu, Maddalena Alessandra and Alfaro-Farias, Mario and Vizmanos-Lamotte, Gerardo and Ksouri, Hatem and Gehring, Nadine and Rezoagli, Emanuele and Turrini, Fabrizio and Lozano-Gómez, Herminia and Carsetti, Andrea and Rodríguez-García, Raquel and Yuen, Bernd and Weber, Anja Baltussen and Castro, Pedro and Escos-Orta, Jesus Oscar and Dullenkopf, Alexander and Martín-Delgado, Maria C. and Aslanidis, Theodoros and Perez, Marie-Helene and Hillgaertner, Frank and Ceruti, Samuele and Franchitti Laurent, Marilene and Marrel, Julien and Colombo, Riccardo and Laube, Marcus and Fogagnolo, Alberto and Studhalter, Michael and Wengenmayer, Tobias and Gamberini, Emiliano and Buerkle, Christian and Buehler, Philipp K. and Keiser, Stefanie and Elhadi, Muhammed and Montomoli, Jonathan and Guerci, Philippe and Fumeaux, Thierry and Schuepbach, Reto A. and Jakob, Stephan M. and Que, Yok-Ai and Hilty, Matthias Peter. (2022) Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry. Critical Care , 26. p. 199.

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It remains elusive how the characteristics, the course of disease, the clinical management and the outcomes of critically ill COVID-19 patients admitted to intensive care units (ICU) worldwide have changed over the course of the pandemic.; Prospective, observational registry constituted by 90 ICUs across 22 countries worldwide including patients with a laboratory-confirmed, critical presentation of COVID-19 requiring advanced organ support. Hierarchical, generalized linear mixed-effect models accounting for hospital and country variability were employed to analyse the continuous evolution of the studied variables over the pandemic.; Four thousand forty-one patients were included from March 2020 to September 2021. Over this period, the age of the admitted patients (62 [95% CI 60-63] years vs 64 [62-66] years, p < 0.001) and the severity of organ dysfunction at ICU admission decreased (Sequential Organ Failure Assessment 8.2 [7.6-9.0] vs 5.8 [5.3-6.4], p < 0.001) and increased, while more female patients (26 [23-29]% vs 41 [35-48]%, p < 0.001) were admitted. The time span between symptom onset and hospitalization as well as ICU admission became longer later in the pandemic (6.7 [6.2-7.2| days vs 9.7 [8.9-10.5] days, p < 0.001). The PaO; 2; /FiO; 2; at admission was lower (132 [123-141] mmHg vs 101 [91-113] mmHg, p < 0.001) but showed faster improvements over the initial 5 days of ICU stay in late 2021 compared to early 2020 (34 [20-48] mmHg vs 70 [41-100] mmHg, p = 0.05). The number of patients treated with steroids and tocilizumab increased, while the use of therapeutic anticoagulation presented an inverse U-shaped behaviour over the course of the pandemic. The proportion of patients treated with high-flow oxygen (5 [4-7]% vs 20 [14-29], p < 0.001) and non-invasive mechanical ventilation (14 [11-18]% vs 24 [17-33]%, p < 0.001) throughout the pandemic increased concomitant to a decrease in invasive mechanical ventilation (82 [76-86]% vs 74 [64-82]%, p < 0.001). The ICU mortality (23 [19-26]% vs 17 [12-25]%, p < 0.001) and length of stay (14 [13-16] days vs 11 [10-13] days, p < 0.001) decreased over 19 months of the pandemic.; Characteristics and disease course of critically ill COVID-19 patients have continuously evolved, concomitant to the clinical management, throughout the pandemic leading to a younger, less severely ill ICU population with distinctly different clinical, pulmonary and inflammatory presentations than at the onset of the pandemic.
Faculties and Departments:03 Faculty of Medicine > Departement Public Health > Institut für Pflegewissenschaft
UniBasel Contributors:Jeitziner, Marie-Madlen
Item Type:Article, refereed
Article Subtype:Research Article
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:05 Jan 2023 08:21
Deposited On:05 Jan 2023 08:21

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