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

• DOI: 10.1016/j.jcrc.2021.06.014
• Publication Date: 2021-06-29T04:46:44Z
• Authors: Alexandre Lopez; Ines Lakbar; Louis Delamarre; Aurélien Culver; Charlotte Arbelot; Gary Duclos; Emmanuelle Hammad; Bruno Pastene; François Antonini; Laurent Zieleskie...; Marc Leone
• Keywords: SARS-CoV-2; [SDV]Life Sciences [q-bio]; COVID-19; 613; Respiration, Artificial; Article; 3. Good health; 618; [SDV] Life Sciences [q-bio]; Intensive Care Units; 03 medical and health sciences; 0302 clinical medicine; Humans; RNA, Viral; Retrospective Studies

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.