Ventilatory therapies and Intensive Care admissions for patients with COVID-19: a systematic review.

OBJECTIVE: The aim of the study was to synthesize and analyze the scientific publications related to ventilatory therapies used in patients with COVID-19 in Intensive Care Units (ICUs), the parameters of invasive mechanical ventilation prescribed for these patients, and the clinical characteristics of patients admitted to the ICU. MATERIALS AND METHODS: A systematic review was carried out through the PubMed, Embase, Web of Science and Cochrane Library databases. Studies published up to 31/05/2020 were included if they made reference to ventilatory therapies used in ICU patients with COVID-19. RESULTS: Qualitative analysis was performed on 30 included studies. A total sample of 48,743 patients was analyzed, of which 17.66% were admitted to ICUs, and 6.4% of these patients died. Of the patients analyzed, 44.4% required some type of respiratory support. Specifically, 12.8% of patients received invasive mechanical ventilation, while 9.7% received non-invasive mechanical ventilation, and 29.7% received high-flow nasal oxygen. CONCLUSIONS: COVID-19 has led to a high number of ICU admissions and a challenge for ICUs is to provide the best ventilatory therapy available to patients admitted. It has been observed that the available figures for ICU admissions and the use of ventilatory therapies are similar across continents. However, the data suggest that geographic areas with higher rates of ICU admission have lower mortality rates. The lack of information in some of the clinical records limits the ability to obtain more conclusive results.

Mortality and critical conditions in COVID-19 patients at private hospitals: weekend effect?

OBJECTIVE: The aim of the study was to find factors associated with the mortality of admission to the intensive care unit (ICU) in patients with COVID-19. MATERIALS AND METHODS: Retrospective observational study with a database of 1987 patients with COVID-19 who had attended the emergency department of a private hospital network between February 2020 and April 2020 were analyzed. Clinical variables and some laboratory parameters were studied. The Charlson and Elixhauser comorbidity indices were calculated. The dependent variables were mortality and admission to the ICU. A descriptive and correlational analysis was performed. Logistic regression models and Kaplan-Meier survival curves were established. RESULTS: Positive correlations were observed between age, creatinine, and D-dimer levels, as well as with the scores obtained with the Charlson and Elixhauser indices. Differences in the levels of these parameters were also observed when analyzing variables such as mortality, sex or admission to the ICU. Mortality was associated with high creatinine and D-dimer levels and advanced age. Survival curves indicated longer survival in patients not admitted to the ICU, admitted to the hospital during the week, and in those with lower creatinine and D-dimer levels. CONCLUSIONS: Mortality in Spanish patients with COVID-19 admitted to private hospitals was associated with high creatinine and D-dimer levels and advanced age. Longer survival was obtained on weekdays. This study provides valuable information on the management and nursing care of these patients in order to optimize resources in pandemic situations.