Abstract
BackgroundWidely varying mortality rates of critically ill Coronavirus disease 19 (COVID-19) patients in the world highlighted the need for local surveillance of baseline characteristics, treatment strategies and outcome. We compared two periods of the COVID-19 pandemic to identify important differences in characteristics and therapeutic measures and their influence on the outcome of critically ill COVID-19 patients.MethodsThis multicenter prospective register study included all patients with a SARS-CoV‑2 infection confirmed by polymerase chain reaction, who were treated in 1 of the 12 intensive care units (ICU) from 8 hospitals in Tyrol, Austria during 2 defined periods (1 February 2020 until 17 July: first wave and 18 July 2020 until 22 February 2021: second wave) of the COVID-19 pandemic.ResultsOverall, 508 patients were analyzed. The majority (n = 401) presented during the second wave, where the median age was significantly higher (64 years, IQR 54–74 years vs. 72 years, IQR 62–78 years, p < 0.001). Invasive mechanical ventilation was less frequent during the second period (50.5% vs 67.3%, p = 0.003), as was the use of vasopressors (50.3% vs. 69.2%, p = 0.001) and renal replacement therapy (12.0% vs. 19.6%, p = 0.061), which resulted in shorter ICU length of stay (10 days, IQR 5–18 days vs. 18 days, IQR 5–31 days, p < 0.001). Nonetheless, ICU mortality did not change (28.9% vs. 21.5%, p = 0.159) and hospital mortality even increased (22.4% vs. 33.4%, p = 0.039) in the second period. Age, frailty and the number of comorbidities were significant predictors of hospital mortality in a multivariate logistic regression analysis of the overall cohort.ConclusionAdvanced treatment strategies and learning effects over time resulted in reduced rates of mechanical ventilation and vasopressor use in the second wave associated with shorter ICU length of stay. Despite these improvements, age appears to be a dominant factor for hospital mortality in critically ill COVID-19 patients.Supplementary InformationThe online version of this article (10.1007/s00508-021-01945-5) contains supplementary material, which is available to authorized users.
Highlights
As of May 2021, more than 600,000 patients tested positive and around 10,000 deaths are attributed to Coronavirus disease 19 (COVID-19) in Austria [1]
Invasive mechanical ventilation was less frequent during the second period (50.5% vs 67.3%, p = 0.003), as was the use of vasopressors (50.3% vs. 69.2%, p = 0.001) and renal replacement therapy (12.0% vs. 19.6%, p = 0.061), which resulted in shorter intensive care unit (ICU) length of stay (10 days, interquartile range (IQR) 5–18 days vs. 18 days, IQR 5–31 days, p < 0.001)
Advanced treatment strategies and learning effects over time resulted in reduced rates of mechanical ventilation and vasopressor use in the second wave associated with shorter ICU length of stay
Summary
As of May 2021, more than 600,000 patients tested positive and around 10,000 deaths are attributed to Coronavirus disease 19 (COVID-19) in Austria [1]. While in the beginning of the pandemic the number of SARS-CoV-2 positive patients requiring intensive care was unknown, the rate settled at around 1–2% during the second period [2]. Due to numerous influencing factors different cohorts from various areas have demonstrated widely varying mortality rates and characteristics of intensive care unit (ICU) patients. Since the beginning of the COVID-19 pandemic, countless studies about therapeutic strategies and the management of ICU patients have been initiated and published [5, 6]. With the RECOVERY trial corticosteroid treatment has shown a mortality benefit in patients requiring respiratory support and has changed therapeutic strategies for critically ill COVID-19 patients. Guidelines have been continuously updated, adapting recommendations based on the best available evidence
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