TY - JOUR
T1 - Critically Ill Adults With Coronavirus Disease 2019 in New Orleans and Care With an Evidence-Based Protocol
AU - Janz, David R.
AU - Mackey, Scott
AU - Patel, Nirav
AU - Saccoccia, Beau P.
AU - St. Romain, Michelle
AU - Busack, Bethany
AU - Lee, Hayoung
AU - Phan, Lana
AU - Vaughn, Jordan
AU - Feinswog, David
AU - Chan, Ryan
AU - Auerbach, Lauren
AU - Sausen, Nicholas
AU - Grace, Joseph
AU - Sackey, Marian
AU - Das, Anushka
AU - Gordon, Angellica O.
AU - Schwehm, Jennifer
AU - McGoey, Robin
AU - Happel, Kyle I.
AU - Kantrow, Stephen P.
N1 - Publisher Copyright:
© 2020 American College of Chest Physicians
PY - 2021/1
Y1 - 2021/1
N2 - Background: Characteristics of critically ill adults with coronavirus disease 2019 (COVID-19) in an academic safety net hospital and the effect of evidence-based practices in these patients are unknown. Research Question: What are the outcomes of critically ill adults with COVID-19 admitted to a network of hospitals in New Orleans, Louisiana, and what is an evidence-based protocol for care associated with improved outcomes? Study Design and Methods: In this multi-center, retrospective, observational cohort study of ICUs in four hospitals in New Orleans, Louisiana, we collected data on adults admitted to an ICU and tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 9, 2020 and April 14, 2020. The exposure of interest was admission to an ICU that implemented an evidence-based protocol for COVID-19 care. The primary outcome was ventilator-free days. Results: The initial 147 patients admitted to any ICU and tested positive for SARS-CoV-2 constituted the cohort for this study. In the entire network, exposure to an evidence-based protocol was associated with more ventilator-free days (25 days; 0-28) compared with non-protocolized ICUs (0 days; 0-23, P =.005), including in adjusted analyses (P =.02). Twenty patients (37%) admitted to protocolized ICUs died compared with 51 (56%; P =.02) in non-protocolized ICUs. Among 82 patients admitted to the academic safety net hospital's ICUs, the median number of ventilator-free days was 22 (interquartile range, 0-27) and mortality rate was 39%. Interpretation: Care of critically ill COVID-19 patients with an evidence-based protocol is associated with increased time alive and free of invasive mechanical ventilation. In-hospital survival occurred in most critically ill adults with COVID-19 admitted to an academic safety net hospital's ICUs despite a high rate of comorbidities.
AB - Background: Characteristics of critically ill adults with coronavirus disease 2019 (COVID-19) in an academic safety net hospital and the effect of evidence-based practices in these patients are unknown. Research Question: What are the outcomes of critically ill adults with COVID-19 admitted to a network of hospitals in New Orleans, Louisiana, and what is an evidence-based protocol for care associated with improved outcomes? Study Design and Methods: In this multi-center, retrospective, observational cohort study of ICUs in four hospitals in New Orleans, Louisiana, we collected data on adults admitted to an ICU and tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 9, 2020 and April 14, 2020. The exposure of interest was admission to an ICU that implemented an evidence-based protocol for COVID-19 care. The primary outcome was ventilator-free days. Results: The initial 147 patients admitted to any ICU and tested positive for SARS-CoV-2 constituted the cohort for this study. In the entire network, exposure to an evidence-based protocol was associated with more ventilator-free days (25 days; 0-28) compared with non-protocolized ICUs (0 days; 0-23, P =.005), including in adjusted analyses (P =.02). Twenty patients (37%) admitted to protocolized ICUs died compared with 51 (56%; P =.02) in non-protocolized ICUs. Among 82 patients admitted to the academic safety net hospital's ICUs, the median number of ventilator-free days was 22 (interquartile range, 0-27) and mortality rate was 39%. Interpretation: Care of critically ill COVID-19 patients with an evidence-based protocol is associated with increased time alive and free of invasive mechanical ventilation. In-hospital survival occurred in most critically ill adults with COVID-19 admitted to an academic safety net hospital's ICUs despite a high rate of comorbidities.
KW - ARDS
KW - COVID-19
KW - critical care
UR - http://www.scopus.com/inward/record.url?scp=85098157160&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85098157160&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2020.08.2114
DO - 10.1016/j.chest.2020.08.2114
M3 - Article
C2 - 32941862
AN - SCOPUS:85098157160
SN - 0012-3692
VL - 159
SP - 196
EP - 204
JO - CHEST
JF - CHEST
IS - 1
ER -