Chronic Critical Illness in Patients with COVID-19: Characteristics and Outcome of Prolonged Intensive Care Therapy.

Kevin Roedl,Stefan Kluge,Dominic Wichmann,Barbara Sensen,Daniel Frings,Dominik Jarczak,Christoph Burdelski,Olaf Boenisch,Geraldine De Heer,Axel Nierhaus

doi:10.3390/jcm11041049

Abstract

The spread of SARS-CoV-2 caused a worldwide healthcare threat. High critical care admission rates related to Coronavirus Disease 2019 (COVID-19) respiratory failure were observed. Medical advances helped increase the number of patients surviving the acute critical illness. However, some patients require prolonged critical care. Data on the outcome of patients with a chronic critical illness (CCI) are scarce. Single-center retrospective study including all adult critically ill patients with confirmed COVID-19 treated at the Department of Intensive Care Medicine at the University Medical Center Hamburg-Eppendorf, Germany, between 1 March 2020 and 8 August 2021. We identified 304 critically ill patients with COVID-19 during the study period. Of those, 55% (n = 167) had an ICU stay ≥21 days and were defined as chronic critical illness, and 45% (n = 137) had an ICU stay <21 days. Age, sex and BMI were distributed equally between both groups. Patients with CCI had a higher median SAPS II (CCI: 39.5 vs. no-CCI: 38 points, p = 0.140) and SOFA score (10 vs. 6, p < 0.001) on admission. Seventy-three per cent (n = 223) of patients required invasive mechanical ventilation (MV) (86% vs. 58%; p < 0.001). The median duration of MV was 30 (17–49) days and 7 (4–12) days in patients with and without CCI, respectively (p < 0.001). The regression analysis identified ARDS (OR 3.238, 95% CI 1.827–5.740, p < 0.001) and referral from another ICU (OR 2.097, 95% CI 1.203–3.654, p = 0.009) as factors significantly associated with new-onset of CCI. Overall, we observed an ICU mortality of 38% (n = 115) in the study cohort. In patients with CCI we observed an ICU mortality of 28% (n = 46) compared to 50% (n = 69) in patients without CCI (p < 0.001). The 90-day mortality was 28% (n = 46) compared to 50% (n = 70), respectively (p < 0.001). More than half of critically ill patients with COVID-19 suffer from CCI. Short and long-term survival rates in patients with CCI were high compared to patients without CCI, and prolonged therapy should not be withheld when resources permit prolonged therapy.

Highlights

It was reported that age, sequential organ failure assessment (SOFA) score, renal and vascular complications serve as independent predictors for a prolonged intensive care unit (ICU) stay [10]
Treatment at the end of the study period or with previous ICU stay related to COVID-19, a total number of 304 critically ill patients were included in the final analysis
We investigated the occurrence of chronic critical illness in critcritically ill patients with COVID-19

Summary

Introduction

Since its initial detection in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread, causing a global healthcare emergency [1]. Of patients with COVID-19 require admission to an intensive care unit (ICU) [2,3,4,5]. Patients at the ICU with COVID-19 suffer from high mortality, especially if invasive mechanical ventilation (MV) is necessary [2,6,7,8,9]. Prolonged ICU therapy can be commonly observed in patients with a need for MV [2,10]. It was reported that age, SOFA score, renal and vascular complications serve as independent predictors for a prolonged ICU stay [10]

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