Padrões de utilização de intervenções terapêuticas em doentes com COVID-19 internados em Unidades de Cuidados Intensivos (UCI)

Abstract

Introduction: COVID-19, declared in March 2020 as a pandemic by the World Health Organization, has reached impacting proportions at a global level, not only in terms of health but also socially and economically. The lack of knowledge about this new disease, its rapid advance, and its great impact on people and health services globally, especially in the area of Intensive Medicine, has led the scientific community around the world to develop, in record time, an unprecedented effort to study, generate data and new knowledge that would allow us to face this enormous challenge. Little was known about the patient admitted to intensive care with COVID-19, which is why extensive work of observation and clinical and scientifically based analysis was required during and after the intensive treatment of these patients in the short, medium, and long term. Objective: To study the temporal evolution of the clinical and epidemiological characteristics, therapeutic approaches, and clinical outcomes of patients admitted to the Intensive Care Unit (ICU) with a diagnosis of SARS-CoV-2 pneumonia during the time frame of the study and advancement of the pandemic in Portugal, between March 2020 and July 2021, through the analysis and comparison of the time periods of the first, second, and third waves and the respective periods between waves. Methodology: The present study was developed in the broader context of a multicenter cohort study in hospitals in the Metropolitan Region of Porto, with the objective of evaluating the short and long-term outcomes of patients with COVID-19 admitted to intensive care units. The population of patients with a suspected or proven diagnosis of SARS-CoV-2 infection, with or without respiratory symptoms, who were hospitalized in ICU for at least 24 hours was studied. The following variables were collected and analyzed: sociodemographic data, the health status of the patient before being hospitalized, comorbidities, disease severity and risk of death, characteristics of critical illness, therapeutic interventions applied during hospitalization in pharmacological and non-pharmacological ICUs ( including need and duration of mechanical ventilation, use of vasopressors and use of renal replacement therapy), length of stay in ICU, ICU mortality and hospital mortality. An analysis and comparison of the time periods of the first, second, and third waves and the respective periods between waves were performed between March 2020 and July 2021. Continuous variables are expressed as medians and interquartile ranges (IQR). Categorical variables are expressed as counts and percentages. Statistical significance was defined as p<0.05 and confidence intervals of 95% for all comparisons. Analyses were performed using SPSS software version 27.0 (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp). Results: Patients admitted to the study were mostly elderly, with a mean age of 65.0 years (57.0 - 72.0), male (67.9%), just over 1/3 were obese, and a high rate of comorbidities was present in 75.9% (Charlson index ≥2). Patients who were admitted during the peak period of vacancies had a higher rate of comorbidities (p<0.001). Over the time periods analyzed, statistically significant differences were also found regarding the need for ventilation, need for vasopressors, pharmacological treatment with antibiotics, hydroxychloroquine, corticosteroids, and remdesivir. Although there were differences in the mortality rate, these were not statistically significant. Discussion: The COVID-19 pandemic has historically constituted one of the greatest challenges to date for medicine and public health at a global level and for intensive care medicine. With this study, the temporal evolution of the clinical and epidemiological characteristics and of the therapeutic approaches and clinical results of critical patients with COVID-19, throughout the initial phases of the evolution of the pandemic, is documented, demonstrating the rapid changes and adaptation that had to exist in order to better manage a reality that is constantly changing and characterized by a great lack of knowledge and uncertainty. Keywords: critically ill, SARS-CoV-2, COVID-19, therapeutic approaches, temporal evolution