Prepandemic ICU performance related to lower COVID mortality rates


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Yesterday in Chest, a review of intensive care units (ICUs) across 10 Brazilian states shows that those with lower mortality rates pre-pandemic saw lower COVID-19 death rates.

Moreover, efficiently managed ICUs also saw lower mortality from the novel coronavirus, suggesting that hospital management is directly linked to patient outcomes.

The study included a total of 386,528 adult patients seen in 33 private Brazilian ICUs from January 2018 to December 2021. Of those patients, 35,619 were admitted to ICUs with a COVID-19 diagnosis.

Researchers used two metrics to determine if ICUs were considered highly efficient before the pandemic: in-hospital patient mortality rates and resource-management metrics in the intensive care centers.

COVID patients were most often in their 50s and 60s, and 64.7% had one or more comorbidities upon ICU admission. A total of 18% required invasive mechanical ventilation (IMV). Among those requiring IMV, in-hospital mortality was between 13% and 54%, and adjusted in-hospital mortality for all ICU patients was wide ranging, from 3.6% to 63.2%.

The least-efficient ICUs, as determined by performance before the pandemic, were independently associated with increased mortality (odds ratio, 2.30; 95% confidence interval, 1.45 to 3.62) after adjusting for patients characteristics, illness severity, and pandemic surge, the authors said.

High-performing ICUs had less variability

Moreover, during pandemic peaks of activity, high-performing ICUs showed less variability in patient mortality and a quicker return to baseline after each wave of activity. The effect was seen most greatly in the first year of the pandemic.

Least efficient centres (before the pandemic) showed higher variability of risk-adjusted mortality, especially during surge periods.

"Least efficient centres (before the pandemic) showed higher variability of risk-adjusted mortality, especially during surge periods, compared to those with better pre-pandemic performance," the authors said.

Overall, the study suggests that targeting improvement in organizational aspects of ICUs would better prepare hospitals for future pandemics.

"Regardless of pandemics, ICUs routinely face periods of high stress and occupancy," said Jorge Salluh, MD, a critical care researcher and study author, in a press release on the study. "Efficient management is a constant benefit for healthcare professionals and their patients. While the risk of death is partly related to the severity of the disease and patient fragility, our study reveals that ICUs management has a direct impact on clinical outcomes."

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