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

• Published in: Critical care explorations Vol. 4; no. 4; p. e0668
• Main Authors: Jimenez, Jose Victor, Olivas-Martinez, Antonio, Rios-Olais, Fausto Alfredo, Ayala-Aguillón, Frida, Gil-López, Fernando, Leal-Villarreal, Mario Andrés de Jesús, Rodríguez-Crespo, Juan José, Jasso-Molina, Juan C, Enamorado-Cerna, Linda, Dardón-Fierro, Francisco Eduardo, Martínez-Guerra, Bernardo A, Román-Montes, Carla Marina, Alvarado-Avila, Pedro E, Juárez-Meneses, Noé Alonso, Morales-Paredes, Luis Alberto, Chávez-Suárez, Adriana, Gutierrez-Espinoza, Irving Rene, Najera-Ortíz, María Paula, Martínez-Becerril, Marina, Gonzalez-Lara, María Fernanda, Ponce de León-Garduño, Alfredo, Baltazar-Torres, José Ángel, Rivero-Sigarroa, Eduardo, Dominguez-Cherit, Guillermo, Hyzy, Robert C, Kershenobich, David, Sifuentes-Osornio, José
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-04-2022; Wolters Kluwer
• Subjects: Observational Study; COVID-19; acute respiratory distress syndrome; mortality; intensive care unit; mechanical ventilation; acute lung injury
• ISSN: 2639-8028; 2639-8028
• DOI: 10.1097/CCE.0000000000000668

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.
To investigate mortality and management of mechanically ventilated patients in temporary ICUs.
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.
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.
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
= 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;
= 0.016).There were no differences in ICU-free days at 28 days (6; IQR, 0-16 vs 2; IQR, 0-15;
= 0.5) or ventilator-free days at 28 days (8; IQR, 0-16 vs 5; IQR, 0-15;
= 0.6). We observed higher reintubation (18% vs 12%;
= 0.029) and readmission (5% vs 1.6%;
= 0.004) rates in conventional ICUs despite higher use of postextubation noninvasive mechanical ventilation (13% vs 8%;
= 0.025). Use of lung-protective ventilation (87% vs 85%;
= 0.5), prone positioning (76% vs 79%;
= 0.4), neuromuscular blockade (96% vs 98%;
= 0.4), and COVID-19 pharmacologic treatment was similar.
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.