Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden.
Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Acta Anaesthesiol Scand. 2023 Jul;67(6):788-796. doi: 10.1111/aas.14232. Epub 2023 Mar 20.
Mortality due to acute hypoxemic respiratory failure (AHRF) in patients with coronavirus disease-19 (COVID-19) differs across units, regions, and countries. These variations may be attributed to several factors, including comorbidities, acute physiological derangement, disease severity, treatment, ethnicity, healthcare system strain, and socioeconomic status. This study aimed to explore the features of patient characteristics, clinical management, and staffing that may be related to mortality among three intensive care units (ICUs) within the same hospital system in South Sweden.
We retrospectively analyzed ICU patients with COVID-19 and AHRF in Region Jönköping County, Sweden. The primary outcome was the 90-day mortality rate. We used univariate and multivariable logistic regression analyses to investigate the relationship of predictors with outcomes.
Between March 15, 2020, and May 31, 2021, 331 patients with AHRF and COVID-19 were admitted to the three ICUs. There were differences in disease severity, treatments, process-related factors, and socioeconomic factors between the units. These factors were related to 90-day mortality. After multivariable adjustment, age, severity of acute respiratory distress syndrome, and the number of nurses per ICU-bed independently predicted 90-day mortality.
Age, disease severity, and nurse staffing, but not treatment or socioeconomic status, were independently associated with 90-day mortality among critically ill patients with AHRF due to COVID-19. We also identified variations in care related processes, which may be a modifiable risk factor and warrants future investigation.
新冠肺炎（COVID-19）患者因急性低氧性呼吸衰竭（AHRF）导致的死亡率在不同单位、地区和国家存在差异。这些差异可能归因于多种因素，包括合并症、急性生理失调、疾病严重程度、治疗、种族、医疗保健系统压力和社会经济地位。本研究旨在探讨可能与瑞典南约特兰地区同一医院系统内的三个重症监护病房（ICU）中患者特征、临床管理和人员配备相关的死亡率特征。
我们回顾性分析了瑞典约特兰地区 COVID-19 合并 AHRF 的 ICU 患者。主要结局是 90 天死亡率。我们使用单变量和多变量逻辑回归分析来研究预测因子与结局的关系。
2020 年 3 月 15 日至 2021 年 5 月 31 日期间，331 例 AHRF 和 COVID-19 患者被收入三个 ICU。三个 ICU 之间存在疾病严重程度、治疗、与流程相关的因素和社会经济因素的差异。这些因素与 90 天死亡率相关。在多变量调整后，年龄、急性呼吸窘迫综合征严重程度和每个 ICU 床位的护士人数独立预测 90 天死亡率。
年龄、疾病严重程度和护士人员配备，但不是治疗或社会经济状况，与 COVID-19 导致的 AHRF 重症患者的 90 天死亡率独立相关。我们还发现与护理相关的流程存在差异，这可能是一个可改变的风险因素，值得进一步研究。
