Management of SARS-CoV-2 pneumonia in intensive care unit: An observational retrospective study comparing two bundles

• Published in: Journal of critical care 2021-10, Vol.65, p.200-204
• Main Authors: Lopez, Alexandre, Lakbar, Ines, Delamarre, Louis, Culver, Aurélien, Arbelot, Charlotte, Duclos, Gary, Hammad, Emmanuelle, Pastene, Bruno, Antonini, François, Zieleskiewicz, Laurent, Leone, Marc
• Format: Article
• Language: English
• Subjects: Antibiotics; Bacteria; Bacterial infections; Bundle; Coronaviruses; COVID-19; Dexamethasone; Drug dosages; Humans; Hydroxychloroquine; Infections; Intensive care; Intensive care unit; Intensive Care Units; Intubation; Length of stay; Life Sciences; Mortality; Normal distribution; Patients; Pneumonia; Polymerase chain reaction; Respiration, Artificial; Retrospective Studies; RNA, Viral; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Steroids; Treatment; Variables; Ventilators
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2021.06.014

To compare the effects of two therapeutic bundles of management in SARS-CoV2 ICU patients. Our retrospective, observational study was performed in a university ICU from March to June 2020 (first wave) and from September 2020 to January 2021 (second wave). In first wave, patients received bundle 1 including early invasive ventilation, hydroxychloroquine, cefotaxime and azithromycin. In second wave, bundle 2 included non-invasive oxygenation support and dexamethasone. The main outcome was in-hospital mortality. Secondary outcomes included ICU and hospital length of stay, ICU supportive therapies, viral clearance and antimicrobial resistance emergence. 129 patients with SARS-CoV-2 pneumonia were admitted to our ICU. Thirty-five were treated according to bundle 1 and 76 to bundle 2. In-hospital mortality was similar in the two groups (23%, p = 1). The hospital (p = 0.003) and ICU (p = 0.01) length of stay and ventilator-free days at 28 days (p = 0.03) were significantly reduced in bundle 2. Increasing age, vasopressor use and PaO2/FiO2 ratio < 125 were associated with in-hospital mortality. Within the limitations of our study, changes in therapeutic bundles for SARS-Cov-2 ICU patients might have no effect on in-hospital mortality but were associated with less exposure to mechanical ventilation and reduced hospital length of stay. •Changes in therapeutic strategies might have no affect in-hospital mortality rate in SARS-CoV-2 pneumonia.•Changes in therapeutic strategies might have reduce the length of stay in intensive care unit and in-hospital.•The management of respiratory support may have influenced outcome's patient.•Other factors as knowledge on COVID-19 physiopathology and improvement in hospital organization may have impacted mortality.