Six-month post-intensive care outcomes during high and low bed occupancy due to the COVID-19 pandemic: A multicenter prospective cohort study
Journal
PLOS ONE
ISSN
1932-6203
Date Issued
2023
Author(s)
Catalina Merino-Osorio
Felipe Muñoz-Muñoz
Type
journal-article
URL Institutional Repository
Abstract
<jats:sec id="sec001">
<jats:title>Introduction</jats:title>
<jats:p>The COVID-19 pandemic can be seen as a natural experiment to test how bed occupancy affects post-intensive care unit (ICU) patient’s functional outcomes. To compare by bed occupancy the frequency of mental, physical, and cognitive impairments in patients admitted to ICU during the COVID-19 pandemic.</jats:p>
</jats:sec>
<jats:sec id="sec002">
<jats:title>Methods</jats:title>
<jats:p>Prospective cohort of adults mechanically ventilated >48 hours in 19 ICUs from seven Chilean public and private hospitals. Ninety percent of nationwide beds occupied was the cut-off for low versus high bed occupancy. At ICU discharge, 3- and 6-month follow-up, we assessed disability using the World Health Organization Disability Assessment Schedule 2.0. Quality of life, mental, physical, and cognitive outcomes were also evaluated following the core outcome set for acute respiratory failure.</jats:p>
</jats:sec>
<jats:sec id="sec003">
<jats:title>Results</jats:title>
<jats:p>We enrolled 252 participants, 103 (41%) during low and 149 (59%) during high bed occupancy. Patients treated during high occupancy were younger (P<jats:sub>50</jats:sub> [P<jats:sub>25</jats:sub>-P<jats:sub>75</jats:sub>]: 55 [44–63] vs 61 [51–71]; p<0.001), more likely to be admitted due to COVID-19 (126 [85%] vs 65 [63%]; p<0.001), and have higher education qualification (94 [63%] vs 48 [47%]; p = 0.03). No differences were found in the frequency of at least one mental, physical or cognitive impairment by bed occupancy at ICU discharge (low vs high: 93% vs 91%; p = 0.6), 3-month (74% vs 63%; p = 0.2) and 6-month (57% vs 57%; p = 0.9) follow-up.</jats:p>
</jats:sec>
<jats:sec id="sec004">
<jats:title>Conclusions</jats:title>
<jats:p>There were no differences in post-ICU outcomes between high and low bed occupancy. Most patients (>90%) had at least one mental, physical or cognitive impairment at ICU discharge, which remained high at 6-month follow-up (57%).</jats:p>
</jats:sec>
<jats:sec id="sec005">
<jats:title>Clinical trial registration</jats:title>
<jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT04979897" xlink:type="simple">NCT04979897</jats:ext-link> (clinicaltrials.gov).</jats:p>
</jats:sec>
<jats:title>Introduction</jats:title>
<jats:p>The COVID-19 pandemic can be seen as a natural experiment to test how bed occupancy affects post-intensive care unit (ICU) patient’s functional outcomes. To compare by bed occupancy the frequency of mental, physical, and cognitive impairments in patients admitted to ICU during the COVID-19 pandemic.</jats:p>
</jats:sec>
<jats:sec id="sec002">
<jats:title>Methods</jats:title>
<jats:p>Prospective cohort of adults mechanically ventilated >48 hours in 19 ICUs from seven Chilean public and private hospitals. Ninety percent of nationwide beds occupied was the cut-off for low versus high bed occupancy. At ICU discharge, 3- and 6-month follow-up, we assessed disability using the World Health Organization Disability Assessment Schedule 2.0. Quality of life, mental, physical, and cognitive outcomes were also evaluated following the core outcome set for acute respiratory failure.</jats:p>
</jats:sec>
<jats:sec id="sec003">
<jats:title>Results</jats:title>
<jats:p>We enrolled 252 participants, 103 (41%) during low and 149 (59%) during high bed occupancy. Patients treated during high occupancy were younger (P<jats:sub>50</jats:sub> [P<jats:sub>25</jats:sub>-P<jats:sub>75</jats:sub>]: 55 [44–63] vs 61 [51–71]; p<0.001), more likely to be admitted due to COVID-19 (126 [85%] vs 65 [63%]; p<0.001), and have higher education qualification (94 [63%] vs 48 [47%]; p = 0.03). No differences were found in the frequency of at least one mental, physical or cognitive impairment by bed occupancy at ICU discharge (low vs high: 93% vs 91%; p = 0.6), 3-month (74% vs 63%; p = 0.2) and 6-month (57% vs 57%; p = 0.9) follow-up.</jats:p>
</jats:sec>
<jats:sec id="sec004">
<jats:title>Conclusions</jats:title>
<jats:p>There were no differences in post-ICU outcomes between high and low bed occupancy. Most patients (>90%) had at least one mental, physical or cognitive impairment at ICU discharge, which remained high at 6-month follow-up (57%).</jats:p>
</jats:sec>
<jats:sec id="sec005">
<jats:title>Clinical trial registration</jats:title>
<jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT04979897" xlink:type="simple">NCT04979897</jats:ext-link> (clinicaltrials.gov).</jats:p>
</jats:sec>
Subjects
adult
;
bed occupancy
;
covid-19
;
critical care
;
humans
;
intensive care units
;
pandemics
;
prospective studies
;
quality of life
;
acute respiratory failure
;
adult
;
anxiety
;
article
;
artificial ventilation
;
body mass
;
charlson comorbidity index
;
cognition
;
cognitive defect
;
cohort analysis
;
coronavirus disease 2019
;
critical care outcome
;
depression
;
disability
;
distress syndrome
;
female
;
follow up
;
health care delivery
;
hospital anxiety and depression scale
;
hospital bed utilization
;
hospital mortality
;
hospitalization
;
human
;
intensive care
;
intensive care unit
;
length of stay
;
major clinical study
;
male
;
multicenter study
;
muscle strength
;
neuropsychological assessment
;
pandemic
;
posttraumatic stress disorder
;
prospective study
;
quality of life
;
questionnaire
;
world health organization disability assessment schedule 2.0
;
clinical trial
;
coronavirus disease 2019
;
intensive care unit
;
pandemic