Elsevier

Journal of Critical Care

Volume 65, October 2021, Pages 200-204
Journal of Critical Care

Management of SARS-CoV-2 pneumonia in intensive care unit: An observational retrospective study comparing two bundles

https://doi.org/10.1016/j.jcrc.2021.06.014Get rights and content

Highlights

  • Changes in therapeutic strategies might have no affect in-hospital mortality rate in SARS-CoV-2 pneumonia.

  • Changes in therapeutic strategies might have reduce the length of stay in intensive care unit and in-hospital.

  • The management of respiratory support may have influenced outcome's patient.

  • Other factors as knowledge on COVID-19 physiopathology and improvement in hospital organization may have impacted mortality.

Abstract

Purpose

To compare the effects of two therapeutic bundles of management in SARS-CoV2 ICU patients.

Materials and methods

Our retrospective, observational study was performed in a university ICU from March to June 2020 (first wave) and from September 2020 to January 2021 (second wave). In first wave, patients received bundle 1 including early invasive ventilation, hydroxychloroquine, cefotaxime and azithromycin. In second wave, bundle 2 included non-invasive oxygenation support and dexamethasone. The main outcome was in-hospital mortality. Secondary outcomes included ICU and hospital length of stay, ICU supportive therapies, viral clearance and antimicrobial resistance emergence.

Results

129 patients with SARS-CoV-2 pneumonia were admitted to our ICU. Thirty-five were treated according to bundle 1 and 76 to bundle 2. In-hospital mortality was similar in the two groups (23%, p = 1). The hospital (p = 0.003) and ICU (p = 0.01) length of stay and ventilator-free days at 28 days (p = 0.03) were significantly reduced in bundle 2. Increasing age, vasopressor use and PaO2/FiO2 ratio < 125 were associated with in-hospital mortality.

Conclusion

Within the limitations of our study, changes in therapeutic bundles for SARS-Cov-2 ICU patients might have no effect on in-hospital mortality but were associated with less exposure to mechanical ventilation and reduced hospital length of stay.

Keywords

COVID-19
Intensive care unit
Treatment
Hydroxychloroquine
Dexamethasone
Bundle

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