Critical Care Explorations (Apr 2022)

Outcomes in Temporary ICUs Versus Conventional ICUs: An Observational Cohort of Mechanically Ventilated Patients With COVID-19–Induced Acute Respiratory Distress Syndrome

  • Jose Victor Jimenez, MD,
  • Antonio Olivas-Martinez, MD,
  • Fausto Alfredo Rios-Olais, MD,
  • Frida Ayala-Aguillón, MD,
  • Fernando Gil- López, MD,
  • Mario Andrés de Jesús Leal-Villarreal, MD,
  • Juan José Rodríguez-Crespo, MD,
  • Juan C. Jasso-Molina, MD,
  • Linda Enamorado-Cerna, MD,
  • Francisco Eduardo Dardón-Fierro, MD,
  • Bernardo A. Martínez-Guerra, MD,
  • Carla Marina Román-Montes, MD,
  • Pedro E. Alvarado-Avila, MD,
  • Noé Alonso Juárez-Meneses, MD,
  • Luis Alberto Morales-Paredes, MD,
  • Adriana Chávez-Suárez, MD,
  • Irving Rene Gutierrez-Espinoza, MD,
  • María Paula Najera-Ortíz, RN M. Ed,
  • Marina Martínez-Becerril, RN M. Ed,
  • María Fernanda Gonzalez-Lara, MD, MsC,
  • Alfredo Ponce de León-Garduño, MD,
  • José Ángel Baltazar-Torres, MD,
  • Eduardo Rivero-Sigarroa, MD,
  • Guillermo Dominguez-Cherit, MD,
  • Robert C. Hyzy, MD,
  • David Kershenobich, MD, PhD,
  • José Sifuentes-Osornio, MD

DOI
https://doi.org/10.1097/CCE.0000000000000668
Journal volume & issue
Vol. 4, no. 4
p. e0668

Abstract

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IMPORTANCE:. Throughout the COVID-19 pandemic, thousands of temporary ICUs have been established worldwide. The outcomes and management of mechanically ventilated patients in these areas remain unknown. OBJECTIVES:. To investigate mortality and management of mechanically ventilated patients in temporary ICUs. DESIGN, SETTING, AND PARTICIPANTS:. Observational cohort study in a single-institution academic center. We included all adult patients with severe COVID-19 hospitalized in temporary and conventional ICUs for invasive mechanical ventilation due to acute respiratory distress syndrome from March 23, 2020, to April 5, 2021. MAIN OUTCOMES AND MEASURES:. To determine if management in temporary ICUs increased 30-day in-hospital mortality compared with conventional ICUs. Ventilator-free days, ICU-free days (both at 28 d), hospital length of stay, and ICU readmission were also assessed. RESULTS:. We included 776 patients (326 conventional and 450 temporary ICUs). Thirty-day in-hospital unadjusted mortality (28.8% conventional vs 36.0% temporary, log-rank test p = 0.023) was higher in temporary ICUs. After controlling for potential confounders, hospitalization in temporary ICUs was an independent risk factor associated with mortality (hazard ratio, 1.4; CI, 1.06–1.83; p = 0.016).There were no differences in ICU-free days at 28 days (6; IQR, 0–16 vs 2; IQR, 0–15; p = 0.5) or ventilator-free days at 28 days (8; IQR, 0–16 vs 5; IQR, 0–15; p = 0.6). We observed higher reintubation (18% vs 12%; p = 0.029) and readmission (5% vs 1.6%; p = 0.004) rates in conventional ICUs despite higher use of postextubation noninvasive mechanical ventilation (13% vs 8%; p = 0.025). Use of lung-protective ventilation (87% vs 85%; p = 0.5), prone positioning (76% vs 79%; p = 0.4), neuromuscular blockade (96% vs 98%; p = 0.4), and COVID-19 pharmacologic treatment was similar. CONCLUSIONS AND RELEVANCE:. We observed a higher 30-day in-hospital mortality in temporary ICUs. Although both areas had high adherence to evidence-based management, hospitalization in temporary ICUs was an independent risk factor associated with mortality.