Trends in Intensive Care for Patients with COVID-19 in England, Wales, and Northern Ireland.
Trends in Intensive Care for Patients with COVID-19 in England, Wales, and Northern Ireland.
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DOI：
10.1164/rccm.202008-3212oc
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发表时间：
2021-03-01
影响因子：
24.7
通讯作者：
Rowan KM
中科院分区：
文献类型：
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作者：
Doidge JC;Gould DW;Ferrando-Vivas P;Mouncey PR;Thomas K;Shankar-Hari M;Harrison DA;Rowan KM
理由：通过描述冠状病毒病 (COVID-19) 患者重症监护的趋势，我们旨在支持临床学习、服务规划和假设生成。目标：描述英格兰、威尔士和北爱尔兰第一波疫情期间 ICU 入院率随时间和地理位置的变化；描述入住 ICU 时患者特征的趋势、入住 ICU 前 24 小时的生理情况、ICU 护理流程和患者治疗结果；并探索高峰期趋势的偏差。方法：使用了 2020 年 2 月 1 日至 7 月 31 日病例混合计划国家临床审核中的 10,741 名 COVID-19 患者队列。分析按时间段（高峰前、高峰和高峰后时段）和地理区域进行分层。 Logistic 回归用于估计不同时期之间 28 天住院死亡率的调整后差异。测量和主要结果：各地区 ICU 的入院率几乎同时达到峰值，但幅度相差 4.6 倍。与高峰期前入院的患者相比，高峰期后入院的患者年龄稍轻，但入住 ICU 时的依赖性和合并症程度更高，且 24 小时内生理紊乱程度更高。尽管如此，有创通气和肾脏替代治疗的接受率有所下降，调整后的 28 天住院死亡率降低了 11.8%（95% 置信区间，8.7%–15.0%）。许多变量在峰值期间呈现出U形或N形曲线。结论：在第一波疫情期间，入住 ICU 的 COVID-19 患者人数以及 ICU 的护理流程发生了变化。在调整重要的风险因素后，患者的治疗结果有了显着的改善。
Rationale: By describing trends in intensive care for patients with coronavirus disease (COVID-19) we aim to support clinical learning, service planning, and hypothesis generation. Objectives: To describe variation in ICU admission rates over time and by geography during the first wave of the epidemic in England, Wales, and Northern Ireland; to describe trends in patient characteristics on admission to ICU, first-24-hours physiology in ICU, processes of care in ICU and patient outcomes; and to explore deviations in trends during the peak period. Methods: A cohort of 10,741 patients with COVID-19 in the Case Mix Program national clinical audit from February 1 to July 31, 2020, was used. Analyses were stratified by time period (prepeak, peak, and postpeak periods) and geographical region. Logistic regression was used to estimate adjusted differences in 28-day in-hospital mortality between periods. Measurements and Main Results: Admissions to ICUs peaked almost simultaneously across regions but varied 4.6-fold in magnitude. Compared with patients admitted in the prepeak period, patients admitted in the postpeak period were slightly younger but with higher degrees of dependency and comorbidity on admission to ICUs and more deranged first-24-hours physiology. Despite this, receipt of invasive ventilation and renal replacement therapy decreased, and adjusted 28-day in-hospital mortality was reduced by 11.8% (95% confidence interval, 8.7%–15.0%). Many variables exhibited u-shaped or n-shaped curves during the peak. Conclusions: The population of patients with COVID-19 admitted to ICUs, and the processes of care in ICUs, changed over the first wave of the epidemic. After adjustment for important risk factors, there was a substantial improvement in patient outcomes.