Division of Neurocritical Care, Department of Neurology and Neurosurgery, School of Medicine, Emory University, Atlanta, GA, USA.
H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
Neurocrit Care. 2023 Apr;38(2):320-325. doi: 10.1007/s12028-022-01559-3. Epub 2022 Jul 13.
COVID-19 surges led to significant challenges in ensuring critical care capacity. In response, some centers leveraged neurocritical care (NCC) capacity as part of the surge response, with neurointensivists providing general critical care for patients with COVID-19 without neurologic illness. The relative outcomes of NCC critical care management of patients with COVID-19 remain unclear and may help guide further surge planning and provide broader insights into general critical care provided in NCC units.
We performed an observational cohort study of all patients requiring critical care for COVID-19 across four hospitals within the Emory Healthcare system during the first three surges. Patients were categorized on the basis of admission to intensive care units (ICUs) staffed by general intensivists or neurointensivists. Patients with primary neurological diagnoses were excluded. Baseline demographics, clinical complications, and outcomes were compared between groups using univariable and propensity score matching statistics.
A total of 1141 patients with a primary diagnosis of COVID-19 required ICU admission. ICUs were staffed by general intensivists (n = 1071) or neurointensivists (n = 70). Baseline demographics and presentation characteristics were similar between groups, except for patients admitted to neurointensivist-staffed ICUs being younger (59 vs. 65, p = 0.027) and having a higher PaO/FiO ratio (153 vs. 120, p = 0.002). After propensity score matching, there was no correlation between ICU staffing and the use of mechanical ventilation, renal replacement therapy, and vasopressors. The rates of in-hospital mortality and hospice disposition were similar in neurointensivist-staffed COVID-19 units (odds ratio 0.9, 95% confidence interval 0.31-2.64, p = 0.842).
COVID-19 surges precipitated a natural experiment in which neurology-trained neurointensivists provided critical care in a comparable context to general intensivists treating the same disease. Neurology-trained neurointensivists delivered comparable outcomes to those of general ICUs during COVID-19 surges. These results further support the role of NCC in meeting general critical care needs of neurocritically ill patients and as a viable surge resource in general critical care.
COVID-19 疫情的爆发给确保重症监护能力带来了巨大挑战。为此，一些中心利用神经重症监护（NCC）能力作为应对疫情的一部分，让神经重症医师为患有 COVID-19 但无神经系统疾病的患者提供一般重症监护。NCC 对 COVID-19 患者进行重症监护的相对结果尚不清楚，这可能有助于指导进一步的疫情应对计划，并为 NCC 病房提供的一般重症监护提供更广泛的见解。
我们对 Emory Healthcare 系统内的四家医院在前三波疫情期间所有需要 COVID-19 重症监护的患者进行了一项观察性队列研究。根据进入由普通重症医师或神经重症医师管理的重症监护病房（ICU）的患者进行分类。排除有原发性神经诊断的患者。使用单变量和倾向评分匹配统计数据比较两组患者的基线人口统计学、临床并发症和结局。
共有 1141 名患有 COVID-19 原发性诊断的患者需要 ICU 入院。ICU 由普通重症医师（n=1071）或神经重症医师（n=70）管理。两组患者的基线人口统计学和表现特征相似，除了入住神经重症医师管理的 ICU 的患者年龄更小（59 岁 vs. 65 岁，p=0.027）和 PaO/FiO 比值更高（153 vs. 120，p=0.002）。在进行倾向评分匹配后，ICU 人员配备与机械通气、肾脏替代治疗和血管加压药的使用之间没有相关性。神经重症医师管理的 COVID-19 病房的住院死亡率和临终关怀安置率相似（比值比 0.9，95%置信区间 0.31-2.64，p=0.842）。
COVID-19 疫情引发了一场自然实验，在此期间，接受神经病学培训的神经重症医师在类似的情况下提供重症监护，与治疗相同疾病的普通重症医师相当。在 COVID-19 疫情期间，接受神经病学培训的神经重症医师与普通 ICU 患者的结果相当。这些结果进一步支持 NCC 在满足神经危重症患者一般重症护理需求方面的作用，以及在一般重症护理方面作为可行的应对资源的作用。
