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Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry

2022; BioMed Central; Volume: 26; Issue: 1 Linguagem: Inglês

10.1186/s13054-022-04065-2

1466-609X

Pedro David Wendel‐Garcia, André Moser, Marie‐Madlen Jeitziner, Hernán Aguirre-Bermeo, Pedro Arias-Sanchez, Janina Apolo, Ferran Roche‐Campo, Diego Franch-Llasat, Gian‐Reto Kleger, Claudia Schrag, Urs Pietsch, Miodrag Filipovic, Sascha David, Klaus Stahl, Souad Bouaoud, Amel Ouyahia, Patricia Fodor, Pascal Locher, Martin Siegemund, Núria Zellweger, Sara Cereghetti, Peter Schott, Gianfilippo Gangitano, Maddalena Alessandra Wu, Mario Alfaro-Farias, Gerardo Vizmanos-Lamotte, Hatem Ksouri, Nadine Gehring, Emanuele Rezoagli, F Turrini, Herminia Lozano-Gómez, Andrea Carsetti, Raquel Rodríguez-García, Bernd Yuen, Anja Baltussen Weber, Pedro Castro, Jesús Escós-Orta, Alexander Dullenkopf, M.C. Martín Delgado, Theodoros Aslanidis, Marie‐Hélène Perez, Frank Hillgaertner, Samuele Ceruti, Marilene Franchitti Laurent, Julien Marrel, Riccardo Colombo, Marcus Laube, Alberto Fogagnolo, Michael Studhalter, Tobias Wengenmayer, Emiliano Gamberini, C. Alex Buerkle, Philipp K. Buehler, Stefanie Keiser, Muhammed Elhadi, Jonathan Montomoli, Philippe Guerci, Thierry Fumeaux, Reto A. Schuepbach, Stephan M. Jakob, Yok‐Ai Que, Matthias P. Hilty, Matthias P. Hilty, Pedro David Wendel‐Garcia, Reto A. Schuepbach, Jonathan Montomoli, Philippe Guerci, Thierry Fumeaux, Souad Bouaoud, Amel Ouyahia, Meriem Abdoun, Mounira Rais, Mario Alfaro-Farias, Gerardo Vizmanos-Lamotte, A. Caballero, Thomas Tschoellitsch, Jens Meier, Hernán Aguirre-Bermeo, Pedro Arias-Sanchez, Janina Apolo, Luis A. Martinez, Hugo Arturo Tirapé Castro, Islam Galal, Samar Tharwat, Ibrahim Abdelmonaem Abdehaleem, Geoffrey Jurkolow, Philippe Guerci, Emmanuel Novy, Marie-Reine Losser, Tobias Wengenmayer, Viviane Zotzmann, Sascha David, Klaus Stahl, Benjamin Seeliger, Tobias Welte, Theodoros Aslanidis, Anita Korsós, Luqman Abdulkhudhur Ahmed, Hashim Talib Hashim, Reza Nikandish, Andrea Carsetti, Erika Casarotta, Paolo Giaccaglia, Emanuele Rezoagli, Matteo Giacomini, Aurora Magliocca, Giuliano Bolondi, Antonella Potalivo, Alberto Fogagnolo, Luca Salvi, Maddalena Alessandra Wu, Chiara Cogliati, Riccardo Colombo, E Catena, F Turrini, Maria Sole Simonini, Silvia Fabbri, Jonathan Montomoli, Emiliano Gamberini, Gianfilippo Gangitano, Maria Maddalena Bitondo, Francesca Maciopinto, Enrico de Camillis, Marta Venturi, Maria Grazia Bocci, Massimo Antonelli, Arowa Alansari, Abdurraouf Abusalama, Osama Omar, Muhannud Binnawara, Hind Alameen, Muhammed Elhadi, Abdulmueti Alhadi, Ahmed Abdullah Husayn Arhaym, Diederik Gommers, Can İnce, Mustafa Abu Jayyab, Mohammed H. Alsharif, Raquel Rodríguez-García, Jorge Gámez-Zapata, Xiana Taboada-Fraga, Pedro Castro, Javier Fernández, Enric Reverter, Arantxa Lander-Azcona, Jesús Escós-Orta, M.C. Martín Delgado, Angela Algaba-Calderon, Ferran Roche‐Campo, Diego Franch-Llasat, Pablo Concha, Esther Sauras-Colón, Herminia Lozano-Gómez, Begoña Zalba-Etayo, Maria P. Montes, Marc Michot, Alexander Klarer, Rolf Ensner, Peter Schott, Severin Urech, Martin Siegemund, Núria Zellweger, Caroline E. Gebhard, Alexa Hollinger, Lukas Merki, Adriana Lambert, Marcus Laube, Marie M. Jeitziner, André Moser, Yok‐Ai Que, Stephan M. Jakob, Jan Wiegand, Bernd Yuen, Barbara Lienhardt-Nobbe, Andrea Westphalen, Petra Salomon, Frank Hillgaertner, Marianne Sieber, Alexander Dullenkopf, Giulio Barana, Hatem Ksouri, Govind Sridharan, Sara Cereghetti, Filippo Boroli, Jérôme Pugin, Serge Grazioli, Christian Bürkle, Julien Marrel, Mirko Brenni, Isabelle Fleisch, Marie‐Hélène Perez, Anne‐Sylvie Ramelet, Anja Baltussen Weber, Peter Gerecke, Andreas Christ, Samuele Ceruti, Andrea Glotta, Maira Biggiogero, Katharina Marquardt, Tobias Hübner, Thomas A. Neff, Hermann Redecker, Thierry Fumeaux, Mallory Moret‐Bochatay, Marco Betello, Friederike Meyer zu Bentrup, Michael Studhalter, Michael Stephan, Nadine Gehring, Daniela Selz, Gian‐Reto Kleger, Claudia Schrag, Urs Pietsch, Miodrag Filipovic, Anette Ristic, Antje Heise, Marilene Franchitti Laurent, Jean-Christophe Laurent, Tomislav Gaspert, Christoph Haberthuer, Patricia Fodor, Pascal Locher, Pedro David Wendel‐Garcia, Matthias P. Hilty, Reto A. Schuepbach, Stefanie Keiser, Dorothea M. Heuberger, Jan Bartussek, Philipp Bühler, Silvio D. Brugger, Eva-Maria Kleinert, Kim-Jana Fehlbier, Aghyad Danial, Maher Almousa, Yazan Abdulbaki, Kamil Sannah, Elif Çolak, Nandor Marczin, S AL-Ameri,

Intensive Care Unit Cognitive Disorders

It remains elusive how the characteristics, the course of disease, the clinical management and the outcomes of critically ill COVID-19 patients admitted to intensive care units (ICU) worldwide have changed over the course of the pandemic.Prospective, observational registry constituted by 90 ICUs across 22 countries worldwide including patients with a laboratory-confirmed, critical presentation of COVID-19 requiring advanced organ support. Hierarchical, generalized linear mixed-effect models accounting for hospital and country variability were employed to analyse the continuous evolution of the studied variables over the pandemic.Four thousand forty-one patients were included from March 2020 to September 2021. Over this period, the age of the admitted patients (62 [95% CI 60-63] years vs 64 [62-66] years, p < 0.001) and the severity of organ dysfunction at ICU admission decreased (Sequential Organ Failure Assessment 8.2 [7.6-9.0] vs 5.8 [5.3-6.4], p < 0.001) and increased, while more female patients (26 [23-29]% vs 41 [35-48]%, p < 0.001) were admitted. The time span between symptom onset and hospitalization as well as ICU admission became longer later in the pandemic (6.7 [6.2-7.2| days vs 9.7 [8.9-10.5] days, p < 0.001). The PaO2/FiO2 at admission was lower (132 [123-141] mmHg vs 101 [91-113] mmHg, p < 0.001) but showed faster improvements over the initial 5 days of ICU stay in late 2021 compared to early 2020 (34 [20-48] mmHg vs 70 [41-100] mmHg, p = 0.05). The number of patients treated with steroids and tocilizumab increased, while the use of therapeutic anticoagulation presented an inverse U-shaped behaviour over the course of the pandemic. The proportion of patients treated with high-flow oxygen (5 [4-7]% vs 20 [14-29], p < 0.001) and non-invasive mechanical ventilation (14 [11-18]% vs 24 [17-33]%, p < 0.001) throughout the pandemic increased concomitant to a decrease in invasive mechanical ventilation (82 [76-86]% vs 74 [64-82]%, p < 0.001). The ICU mortality (23 [19-26]% vs 17 [12-25]%, p < 0.001) and length of stay (14 [13-16] days vs 11 [10-13] days, p < 0.001) decreased over 19 months of the pandemic.Characteristics and disease course of critically ill COVID-19 patients have continuously evolved, concomitant to the clinical management, throughout the pandemic leading to a younger, less severely ill ICU population with distinctly different clinical, pulmonary and inflammatory presentations than at the onset of the pandemic.