Critical Care Explorations (Feb 2022)

Hospital Variation in Management and Outcomes of Acute Respiratory Distress Syndrome Due to COVID-19

  • Shelsey W. Johnson, MD,
  • Michael A. Garcia, MD,
  • Emily K. Q. Sisson, MA,
  • Christopher R. Sheldrick, PhD,
  • Vishakha K. Kumar, MD, MBA,
  • Karen Boman, BA,
  • Scott Bolesta, PharmD,
  • Vikas Bansal, MBBS, MPH,
  • Amos Lal, MBBS,
  • J. P. Domecq, MD, MS,
  • Roman R. Melamed, MD,
  • Amy B. Christie, MD,
  • Abdurrahman Husain, MD,
  • Santiago Yus, MBBS,
  • Ognjen Gajic, MD, MSc,
  • Rahul Kashyap, MBBS, MBA,
  • Allan J. Walkey, MD, MSc,
  • from the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group,
  • Oscar Y. Gavidia,
  • Felipe Pachon,
  • Yeimy A. Sanchez,
  • Mohamed El Kassas,
  • Mohamed Badr,
  • Ahmed Tawheed,
  • Ahmed Tawheed,
  • Hend Yahia,
  • Wataru Matsuda,
  • Reina Suzuki,
  • Reina Suzuki,
  • Masamitsu Sanui,
  • Sho Horikita,
  • Yuki Itagaki,
  • Akira Kodate,
  • Reina Suzuki,
  • Akira Kodate,
  • Yuki Takahashi,
  • Koyo Moriki,
  • Muhammad Sohaib,
  • Asghar, Mashaal Syed,
  • Syed Anosh,
  • Ali Naqvi,
  • Borisovich Zabolotskikh,
  • Konstantin Dmitrievich Zybin,
  • Sergey Vasilevich Sinkov,
  • Tatiana Sergeevna Musaeva,
  • Mohammed A. Almazyad,
  • Mohammed I. Alarifi,
  • Jara M. Macarambon,
  • Ahmad Abdullah Bukhari,
  • Hussain A. Albahrani,
  • Kazi N. Asfina,
  • Kaltham M. Aldossary,
  • Marija Zdravkovic,
  • Zoran Todorovic,
  • Viseslav Popadic,
  • Slobodan Klasnja,
  • Predrag D. Stevanovic,
  • Dejan S. Stojakov,
  • Duska K. Ignjatovic,
  • Suzana C. Bojic,
  • Marina M. Bobos,
  • Irina B. Nenadic,
  • Milica S. Zaric,
  • Marko D. Djuric,
  • Vladimir R. Djukic,
  • Santiago Yus,
  • Belen C. Martin,
  • Uluhan Sili,
  • Huseyin Bilgin,
  • Pinar Ay,
  • Roman R. Melamed,
  • David M. Tierney,
  • Love A. Patel,
  • Vino S. Raj,
  • Barite U. Dawud,
  • Narayana Mazumder,
  • Abbey Sidebottom,
  • Alena M. Guenther,
  • Benjamin D. Krehbiel,
  • Nova J. Schmitz,
  • Stacy L. Jepsen,
  • Lynn Sipsey,
  • Anna Schulte,
  • Whitney Wunderlich,
  • Cecely Hoyt,
  • Kenneth W. Dodd,
  • Nicholas Goodmanson,
  • Kathleen Hesse,
  • Paige Bird,
  • Chauncey Weinert,
  • Nathan Schoenrade,
  • Abdulrahman Altaher,
  • Esmael Mayar,
  • Matthew Aronson,
  • Tyler Cooper,
  • Monica Logan,
  • Brianna Miner,
  • Gisele Papo,
  • Abdulrahman Al-Fares,
  • Anmol Kharbanda,
  • Sunil Jhajhria,
  • Zachary Fyffe,
  • Amy B. Christie,
  • Dennis W. Ashley,
  • Rajani Adiga,
  • Andrea Sikora Newsome,
  • Christy C. Forehand,
  • Rebecca Bruning,
  • Timothy W. Jones,
  • Moldovan Sabov,
  • Fatema Zaidi,
  • Fiona Tissavirasingham,
  • Dhatri Malipeddi,
  • Valerie M. Banner-Goodspeed,
  • Somnath Bose,
  • Lauren E. Kelly,
  • Melisa Joseph,
  • Marie McGourty,
  • Krystal Capers,
  • Benjamin Hoenig,
  • Maria C. Karamourtopoulos,
  • Anica C. Law,
  • Elias N. Baedorf Kassis,
  • Allan J. Walkey,
  • Sushrut S. Waikar,
  • Michael A. Garcia,
  • Mia Colona,
  • Zoe Kibbelaar,
  • Michael Leong,
  • Daniel Wallman,
  • Kanupriya Soni,
  • Jennifer Maccarone,
  • Joshua Gilman,
  • Ycar Devis,
  • Joseph Chung,
  • Munizay Paracha,
  • David N. Lumelsky,
  • Madeline DiLorenzo,
  • Najla Abdurrahman,
  • Shelsey Johnson,
  • Kimberly Zammit,
  • Patrick J. McGrath,
  • William Loeffler,
  • Maya R. Chilbert,
  • Jean-Baptiste Mesland,
  • Pierre Henin,
  • Hélène Petre,
  • Isabelle Buelens,
  • Anne-Catherine Gerard,
  • Rayan E. Ihle,
  • Shelda A. Martin,
  • Elaine A. Davis,
  • Salim Surani,
  • Joshua White,
  • Aftab Khan,
  • Rahul Dhahwal,
  • Sreekanth Cheruku,
  • Farzin Ahmed,
  • Christopher Deonarine,
  • Ashley Jones,
  • Mohammad-Ali Shaikh,
  • David Preston,
  • Jeanette Chin,
  • Steven K. Daugherty,
  • Sam Atkinson,
  • Kelly Shrimpton,
  • Raquel R. Bartz,
  • Vijay Krishnamoorthy,
  • Bryan Kraft,
  • Aaron Pulsipher,
  • Eugene Friedman,
  • Sachin Mehta,
  • David P. Yamane,
  • Ivy Benjenk,
  • Nivedita Prasanna,
  • Katharine Nault,
  • Ronald A. Reilkoff,
  • Julia A. Heneghan,
  • Sarah Eichen,
  • Lexie Goertzen,
  • Scott Rajala,
  • Ghislaine Feussom,
  • Ben Tang,
  • Mayo Clinic Arizona,
  • Rodrigo Cartin-Ceba,
  • Ayan Sen,
  • Amanda Palacios,
  • Giyth M. Mahdi,
  • Rahul Kashyap,
  • Ognjen Gajic,
  • Vikas Bansal,
  • Aysun Tekin,
  • Amos Lal,
  • John C. O’Horo,
  • Neha N. Deo,
  • Mayank Sharma,
  • Shahraz Qamar,
  • Juan Pablo Domecq,
  • Romil Singh,
  • Alex Niven,
  • Mayo Clinic,
  • Eau Claire,
  • Abigail T. La Nou,
  • Marija Bogojevic,
  • Barbara Mullen,
  • Devang Sanghavi,
  • Pramod Guru,
  • Pablo Moreno Franco,
  • Karthik Gnanapandithan,
  • Hollie Saunders,
  • Zachary Fleissner,
  • Juan Garcia,
  • Alejandra Yu Lee Mateus,
  • Siva Naga Yarrarapu,
  • Nirmaljot Kaur,
  • Abhisekh Giri,
  • Syed Anjum Khan,
  • Nitesh Kumar Jain,
  • Thoyaja Koritala,
  • Chakradhar Venkata,
  • Miriam Engemann,
  • Annamarie Mantese,
  • Yasir Tarabichi,
  • Adam Perzynski,
  • Christine Wang,
  • Dhatri Kotekal,
  • Bhagat S. Aulakh,
  • Sandeep Tripathi,
  • Jennifer A. Bandy,
  • Lisa M. Kreps,
  • Dawn R. Bollinger,
  • Jennifer A. Bandy,
  • Roger Scott Stienecker,
  • Andre G. Melendez,
  • Tressa A. Brunner,
  • Sue M. Budzon,
  • Jessica L. Heffernan,
  • Janelle M. Souder,
  • Tracy L. Miller,
  • Andrea G. Maisonneuve,
  • Antonia L. Vilella,
  • Sara B. Kutner,
  • Kacie Clark,
  • Danielle Moore,
  • Harry L. Anderson, III,
  • Dixy Rajkumar,
  • Ali Abunayla,
  • Jerrilyn Heiter,
  • Howard A. Zaren,
  • Stephanie J. Smith,
  • Grant C. Lewis,
  • Lauren Seames,
  • Cheryl Farlow,
  • Judy Miller,
  • Gloria Broadstreet,
  • Anthony Martinez,
  • Micheal Allison,
  • Aniket Mittal,
  • Rafael Ruiz,
  • Aleta Skaanland,
  • Robert Ross,
  • Neha Gupta,
  • Tracy L. Jones,
  • Shonda C. Ayers,
  • Amy B. Harrell,
  • Dr. Brent R. Brown,
  • Abdurrahman Husain,
  • Atul Malhotra,
  • Qais Zawaydeh,
  • Dragana Markotić,
  • Ivana Bošnjak,
  • Emily A. Vail,
  • Susannah Nicholson,
  • Rachelle B. Jonas,
  • AnnaRose E. Dement,
  • William Tang,
  • Mark DeRosa,
  • Robert E. Villarreal,
  • Patrick W. McGonagill,
  • Colette Galet,
  • Janice Hubbard,
  • David Wang,
  • Lauren Allan,
  • Aditya Badheka,
  • Madhuradhar Chegondi,
  • Roger A. Alvarez,
  • Amarilys Alarcon-Calderon,
  • Marie Anne Sosa,
  • Sunita K. Mahabir,
  • Mausam J. Patel,
  • Faraaz Ali Shah,
  • Byron Chuan,
  • Sagar L. Rawal,
  • Manal Piracha,
  • Joseph E. Tonna,
  • Nicholas M. Levin,
  • Kayte Suslavich,
  • Rachel Tsolinas,
  • Zachary T. Fica,
  • Chloe R. Skidmore,
  • Renee D. Stapleton,
  • Anne E. Dixon,
  • Olivia Johnson,
  • Sara S. Ardren,
  • Stephanie Burns,
  • Anna Raymond,
  • Erika Gonyaw,
  • Kevin Hodgdon,
  • Chloe Housenger,
  • Benjamin Lin,
  • Karen McQuesten,
  • Heidi Pecott-Grimm,
  • Julie Sweet,
  • Sebastian Ventrone,
  • Murtaza Akhter,
  • Rania Abdul Rahman,
  • Mary Mulrow,
  • Ashish K. Khanna,
  • Lynne Harris,
  • Bruce Cusson,
  • Jacob Fowler,
  • David Vaneenenaam,
  • Glen McKinney,
  • Imoh Udoh,
  • Kathleen Johnson,
  • Vishwanath Pattan,
  • Jessica Papke,
  • Ismail Jimada,
  • Nida Mhid,
  • Samuel Chakola

DOI
https://doi.org/10.1097/CCE.0000000000000638
Journal volume & issue
Vol. 10, no. 2
p. e0638

Abstract

Read online

OBJECTIVES:. To describe hospital variation in use of “guideline-based care” for acute respiratory distress syndrome (ARDS) due to COVID-19. DESIGN:. Retrospective, observational study. SETTING:. The Society of Critical Care Medicine’s Discovery Viral Infection and RESPIRATORY ILLNESS UNIVERSAL STUDY COVID-19 REGISTRY. PATIENTS:. Adult patients with ARDS due to COVID-19 between February 15, 2020, and April 12, 2021. INTERVENTIONS:. Hospital-level use of “guideline-based care” for ARDS including low-tidal-volume ventilation, plateau pressure less than 30 cm H2O, and prone ventilation for a Pao2/Fio2 ratio less than 100. MEASUREMENTS AND MAIN RESULTS:. Among 1,495 adults with COVID-19 ARDS receiving care across 42 hospitals, 50.4% ever received care consistent with ARDS clinical practice guidelines. After adjusting for patient demographics and severity of illness, hospital characteristics, and pandemic timing, hospital of admission contributed to 14% of the risk-adjusted variation in “guideline-based care.” A patient treated at a randomly selected hospital with higher use of guideline-based care had a median odds ratio of 2.0 (95% CI, 1.1–3.4) for receipt of “guideline-based care” compared with a patient receiving treatment at a randomly selected hospital with low use of recommended therapies. Median-adjusted inhospital mortality was 53% (interquartile range, 47–62%), with a nonsignificantly decreased risk of mortality for patients admitted to hospitals in the highest use “guideline-based care” quartile (49%) compared with the lowest use quartile (60%) (odds ratio, 0.7; 95% CI, 0.3–1.9; p = 0.49). CONCLUSIONS:. During the first year of the COVID-19 pandemic, only half of patients received “guideline-based care” for ARDS management, with wide practice variation across hospitals. Strategies that improve adherence to recommended ARDS management strategies are needed.