Changing Critical Care Patterns and Associated Outcomes in Mechanically Ventilated Severe COVID-19 Patients in Different Time Periods: An Explanatory Study from Central India

Saurabh Saigal; Ankur Joshi; Rajesh Panda; Abhishek Goyal; Saiteja Kodamanchili; Abhijeet Anand; Dodda Brahmam; Surya Jha; Abhijit Pakhare; Sunaina Tejpal Karna; Alkesh Khurana; Pooja Singh; Yogesh Niwariya; Sagar Khadanga; Jai Prakash Sharma; Rajnish Joshi

doi:10.5005/jp-journals-10071-24279

Changing Critical Care Patterns and Associated Outcomes in Mechanically Ventilated Severe COVID-19 Patients in Different Time Periods: An Explanatory Study from Central India

Indian J Crit Care Med. 2022 Sep;26(9):1022-1030. doi: 10.5005/jp-journals-10071-24279.

Authors

Saurabh Saigal¹, Ankur Joshi², Rajesh Panda¹, Abhishek Goyal³, Saiteja Kodamanchili¹, Abhijeet Anand¹, Dodda Brahmam¹, Surya Jha¹, Abhijit Pakhare², Sunaina Tejpal Karna¹, Alkesh Khurana³, Pooja Singh¹, Yogesh Niwariya⁴, Sagar Khadanga⁵, Jai Prakash Sharma¹, Rajnish Joshi⁶

Affiliations

¹ Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
² Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
³ Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
⁴ Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
⁵ Department of Medicine, AIIMS Bhopal Saket Nagar, Bhopal, Madhya Pradesh, India.
⁶ Department of Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.

Abstract

Background: The outcomes in critical illness depend on disease severity, practice protocols, workload, and access to care. This study investigates the factors affecting outcomes in mechanically ventilated coronavirus disease-2019 acute respiratory distress syndrome (COVID-19 ARDS) patients admitted in a tertiary teaching hospital intensive care unit (ICU) in Central India with reference to different time periods in pandemic. This is one of the largest series of mechanically ventilated COVID-19 ARDS patients, globally.

Methods: This retrospective cohort study classified the entire data into four time periods (Period 1: April 2020 to June 2020; Period 2: July 2020 to September 2020; Period 3: October 2020 to December 2020; and Period 4: January 2021 to April 2021). We performed a multivariable-adjusted analysis to evaluate predictors of mortality, adjusted for baseline-severity, sequential organ failure assessment (SOFA score) and time period. We applied mixed-effect binomial logistic regression to model fixed-effect variables with incremental complexity.

Results: Among the 56 survivors (19.4%) out of 288 mechanically ventilated patients, there was an up-gradient of survival proportion (0, 18.2, 17.4, and 28.6%) in four time periods. Symptom-intubation interval (OR 1.16; 95% CI 1.03-1.31) and driving pressures (DPs) (OR 1.17; 95% CI 1.07-1.28) were significant predictors of mortality in the model having minimal AIC and BIC values. Patients aged above 60 years also had a larger effect, but statistically insignificant effect favoring mortality (OR 1.99; 95% CI 0.92-4.27). The most complex but less parsimonious model (with higher AIC/BIC) indicated the protective odds of high steroid on mortality (OR 0.59; 95% CI 0.59-0.82).

Conclusion: The outcomes in mechanically ventilated COVID-19 ARDS patients are heterogeneous across time windows and may be affected by the complex interaction of baseline risk and critical care parameters.

How to cite this article: Saigal S, Joshi A, Panda R, Goyal A, Kodamanchili S, Anand A, et al. Changing Critical Care Patterns and Associated Outcomes in Mechanically Ventilated Severe COVID-19 Patients in Different Time Periods: An Explanatory Study from Central India. Indian J Crit Care Med 2022;26(9):1022-1030.

Keywords: Acute respiratory distress syndrome; Coronavirus disease-2019; Intensive care unit; Mechanical ventilation.