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
Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Crit Care Explor. 2022 Mar 28;4(4):e0668. doi: 10.1097/CCE.0000000000000668. eCollection 2022 Apr.
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.
在整个新冠疫情期间，全球建立了数千个临时重症监护病房（ICU）。这些区域接受机械通气患者的治疗结果和管理情况仍不明确。
调查临时ICU中接受机械通气患者的死亡率和管理情况。
设计、设置和参与者：在一个单机构学术中心进行的观察性队列研究。我们纳入了2020年3月23日至2021年4月5日期间因急性呼吸窘迫综合征在临时和传统ICU住院接受有创机械通气的所有成年重症新冠患者。
确定与传统ICU相比，临时ICU的管理是否会增加30天院内死亡率。还评估了无呼吸机天数、无ICU天数（均为28天时）、住院时间和ICU再入院情况。
我们纳入了776例患者（326例在传统ICU，450例在临时ICU）。临时ICU的30天院内未调整死亡率更高（传统ICU为28.8%，临时ICU为36.0%，对数秩检验P = 0.023）。在控制潜在混杂因素后，在临时ICU住院是与死亡率相关的独立危险因素（风险比为1.4；可信区间为1.06 - 1.83；P = 0.016）。28天时的无ICU天数（分别为6天；四分位数间距为0 - 16天与2天；四分位数间距为0 - 15天；P = 0.5）或28天时的无呼吸机天数（分别为8天；四分位数间距为0 - 16天与5天；四分位数间距为0 - 15天；P = 0.6）没有差异。尽管传统ICU更高比例地使用拔管后无创机械通气（13%对8%；P = 0.025），但我们观察到传统ICU的再插管率（18%对12%；P = 0.029）和再入院率（5%对1.6%；P = 0.004）更高。肺保护性通气的使用（87%对85%；P = 0.5）、俯卧位通气（76%对79%；P = 0.4）、神经肌肉阻滞（96%对98%；P = 0.4）以及新冠药物治疗情况相似。
我们观察到临时ICU的30天院内死亡率更高。尽管两个区域对循证管理的依从性都很高，但在临时ICU住院是与死亡率相关的独立危险因素。
