Comparison of characteristics and ventilatory course between coronavirus disease 2019 and Middle East respiratory syndrome patients with acute respiratory distress syndrome.

BACKGROUND: Both coronavirus disease 2019 (COVID-19) and Middle East respiratory syndrome (MERS) can cause acute respiratory distress syndrome (ARDS); however, their ARDS course and characteristics have not been compared, which we evaluate in our study. METHODS: MERS patients with ARDS seen during the 2014 outbreak and COVID-19 patients with ARDS admitted between March and December 2020 in our hospital were included, and their clinical characteristics, ventilatory course, and outcomes were compared. RESULTS: Forty-nine and 14 patients met the inclusion criteria for ARDS in the COVID-19 and MERS groups, respectively. Both groups had a median of four comorbidities with high Charlson comorbidity index value of 5 points (P>0.22). COVID-19 patients were older, obese, had significantly higher initial C-reactive protein (CRP), more likely to get trial of high-flow oxygen, and had delayed intubation (P≤0.04). The postintubation course was similar between the groups. Patients in both groups experienced a prolonged duration of mechanical ventilation, and majority received paralytics, dialysis, and vasopressor agents (P>0.28). The respiratory and ventilatory parameters after intubation (including tidal volume, fraction of inspired oxygen, peak and plateau pressures) and their progression over 3 weeks were similar (P>0.05). Rates of mortality in the ICU (53% vs. 64%) and hospital (59% vs. 64%) among COVID-19 and MERS patients (P≥0.54) were very high. CONCLUSIONS: Despite some distinctive differences between COVID-19 and MERS patients prior to intubation, the respiratory and ventilatory parameters postintubation were not different. The higher initial CRP level in COVID-19 patients may explain the steroid responsiveness in this population.

Comparison of Clinical Characteristics and End-of-Life Care Between COVID-19 and Non-COVID-19 Muslim Patients During the 2020 Pandemic.

BACKGROUND: Little is known about end-of-life care among Muslim patients, particularly during Coronavirus disease 2019 (COVID) pandemic, which we report here. METHODS: The clinical characteristics, end-of-life care and resuscitation status of Muslim patients who died in the ICU of our tertiary care hospital in year 2020 from COVID were compared to Non-COVID patients. RESULTS: There were 32 patients in COVID and 64 in the Non-COVID group. A major proportion, mainly of Non-COVID patients, already had a hospice eligible terminal disease at baseline (p=.002). COVID patients were admitted to the ICU sooner after hospitalization (2.2 vs. 17 days), had prolonged duration of mechanical ventilation (18.5 vs. 6 days) and longer ICU stay (24 vs. 8 days) than non-COVID patients, respectively (p<.001). Almost all patients were "Full Code" initially. However, status was eventually changed to 'do-not-attempt resuscitation' (DNAR) in about 60% of the cohort. COVID patients were made DNAR late in their ICU stay, predominantly in the last 24 hours of life (p=.04). Until the very end, patients in both groups were on tube feeds, underwent blood draws and imaging, required high dose vasopressors, with few limitations or withdrawal of therapies. Family members were usually not present at bedside at time of death. There was minimal involvement of chaplain and palliative care services. CONCLUSIONS: Muslim COVID-19 patients had prolonged mechanical ventilation and ICU stay and a delayed decision to DNAR status than non-COVID Muslim patients. Limitation or withdrawal of therapy occurred infrequently. The utilization of chaplain and palliative care service needs improvement.