tetano
Editor, Senior Moderator
Crit Care Explor
. 2022 Feb 18;10(2):e0638.
doi: 10.1097/CCE.0000000000000638. eCollection 2022 Feb.
Hospital Variation in Management and Outcomes of Acute Respiratory Distress Syndrome Due to COVID-19
Shelsey W Johnson[SUP] 1 [/SUP], Michael A Garcia[SUP] 1 [/SUP], Emily K Q Sisson[SUP] 2 [/SUP], Christopher R Sheldrick[SUP] 2 [/SUP], Vishakha K Kumar[SUP] 3 [/SUP], Karen Boman[SUP] 3 [/SUP], Scott Bolesta[SUP] 4 [/SUP], Vikas Bansal[SUP] 5 [/SUP], Amos Lal[SUP] 6 [/SUP], J P Domecq[SUP] 7 [/SUP], Roman R Melamed[SUP] 8 [/SUP], Amy B Christie[SUP] 9 [/SUP], Abdurrahman Husain[SUP] 10 [/SUP], Santiago Yus[SUP] 11 [/SUP], Ognjen Gajic[SUP] 6 [/SUP], Rahul Kashyap[SUP] 5 [/SUP], Allan J Walkey[SUP] 1 12 [/SUP]
Affiliations
Abstract
Objectives: To describe hospital variation in use of "guideline-based care" for acute respiratory distress syndrome (ARDS) due to COVID-19.
Design: Retrospective, observational study.
Setting: The Society of Critical Care Medicine's Discovery Viral Infection and RESPIRATORY ILLNESS UNIVERSAL STUDY COVID-19 REGISTRY.
Patients: Adult patients with ARDS due to COVID-19 between February 15, 2020, and April 12, 2021.
Interventions: Hospital-level use of "guideline-based care" for ARDS including low-tidal-volume ventilation, plateau pressure less than 30 cm H[SUB]2[/SUB]O, and prone ventilation for a Pao[SUB]2[/SUB]/Fio[SUB]2[/SUB] ratio less than 100.
Measurements and main results: Among 1,495 adults with COVID-19 ARDS receiving care across 42 hospitals, 50.4% ever received care consistent with ARDS clinical practice guidelines. After adjusting for patient demographics and severity of illness, hospital characteristics, and pandemic timing, hospital of admission contributed to 14% of the risk-adjusted variation in "guideline-based care." A patient treated at a randomly selected hospital with higher use of guideline-based care had a median odds ratio of 2.0 (95% CI, 1.1-3.4) for receipt of "guideline-based care" compared with a patient receiving treatment at a randomly selected hospital with low use of recommended therapies. Median-adjusted inhospital mortality was 53% (interquartile range, 47-62%), with a nonsignificantly decreased risk of mortality for patients admitted to hospitals in the highest use "guideline-based care" quartile (49%) compared with the lowest use quartile (60%) (odds ratio, 0.7; 95% CI, 0.3-1.9; p = 0.49).
Conclusions: During the first year of the COVID-19 pandemic, only half of patients received "guideline-based care" for ARDS management, with wide practice variation across hospitals. Strategies that improve adherence to recommended ARDS management strategies are needed.
Keywords: COVID-19; Viral Infection and Respiratory Illness Universal Study; acute respiratory distress syndrome; low-tidal-volume ventilation; prone ventilation; severe acute respiratory syndrome coronavirus-2.
. 2022 Feb 18;10(2):e0638.
doi: 10.1097/CCE.0000000000000638. eCollection 2022 Feb.
Hospital Variation in Management and Outcomes of Acute Respiratory Distress Syndrome Due to COVID-19
Shelsey W Johnson[SUP] 1 [/SUP], Michael A Garcia[SUP] 1 [/SUP], Emily K Q Sisson[SUP] 2 [/SUP], Christopher R Sheldrick[SUP] 2 [/SUP], Vishakha K Kumar[SUP] 3 [/SUP], Karen Boman[SUP] 3 [/SUP], Scott Bolesta[SUP] 4 [/SUP], Vikas Bansal[SUP] 5 [/SUP], Amos Lal[SUP] 6 [/SUP], J P Domecq[SUP] 7 [/SUP], Roman R Melamed[SUP] 8 [/SUP], Amy B Christie[SUP] 9 [/SUP], Abdurrahman Husain[SUP] 10 [/SUP], Santiago Yus[SUP] 11 [/SUP], Ognjen Gajic[SUP] 6 [/SUP], Rahul Kashyap[SUP] 5 [/SUP], Allan J Walkey[SUP] 1 12 [/SUP]
Affiliations
- PMID: 35211681
- PMCID: PMC8860338
- DOI: 10.1097/CCE.0000000000000638
Abstract
Objectives: To describe hospital variation in use of "guideline-based care" for acute respiratory distress syndrome (ARDS) due to COVID-19.
Design: Retrospective, observational study.
Setting: The Society of Critical Care Medicine's Discovery Viral Infection and RESPIRATORY ILLNESS UNIVERSAL STUDY COVID-19 REGISTRY.
Patients: Adult patients with ARDS due to COVID-19 between February 15, 2020, and April 12, 2021.
Interventions: Hospital-level use of "guideline-based care" for ARDS including low-tidal-volume ventilation, plateau pressure less than 30 cm H[SUB]2[/SUB]O, and prone ventilation for a Pao[SUB]2[/SUB]/Fio[SUB]2[/SUB] ratio less than 100.
Measurements and main results: Among 1,495 adults with COVID-19 ARDS receiving care across 42 hospitals, 50.4% ever received care consistent with ARDS clinical practice guidelines. After adjusting for patient demographics and severity of illness, hospital characteristics, and pandemic timing, hospital of admission contributed to 14% of the risk-adjusted variation in "guideline-based care." A patient treated at a randomly selected hospital with higher use of guideline-based care had a median odds ratio of 2.0 (95% CI, 1.1-3.4) for receipt of "guideline-based care" compared with a patient receiving treatment at a randomly selected hospital with low use of recommended therapies. Median-adjusted inhospital mortality was 53% (interquartile range, 47-62%), with a nonsignificantly decreased risk of mortality for patients admitted to hospitals in the highest use "guideline-based care" quartile (49%) compared with the lowest use quartile (60%) (odds ratio, 0.7; 95% CI, 0.3-1.9; p = 0.49).
Conclusions: During the first year of the COVID-19 pandemic, only half of patients received "guideline-based care" for ARDS management, with wide practice variation across hospitals. Strategies that improve adherence to recommended ARDS management strategies are needed.
Keywords: COVID-19; Viral Infection and Respiratory Illness Universal Study; acute respiratory distress syndrome; low-tidal-volume ventilation; prone ventilation; severe acute respiratory syndrome coronavirus-2.