Open AccessOutcomes of patients with COVID-19 acute respiratory distress syndrome requiring invasive mechanical ventilation admitted to an intensive care unit in South Africa
Author(s) -
Christel Arnold-Day,
Richard N. van Zyl-Smit,
Ivan Joubert,
David Thomson,
David Fredericks,
Malcolm Miller,
W L Michell,
Patrick Semple,
J Piercy
Publication year - 2021
Publication title -
samj. south african medical journal/south african medical journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.527
H-Index - 57
eISSN - 2078-5135
pISSN - 0256-9574
DOI - 10.7196/samj.2022.v112i1.16115
Subject(s) - medicine , interquartile range , ards , mechanical ventilation , intensive care unit , pneumonia , fraction of inspired oxygen , odds ratio , sofa score , intensive care , body mass index , prospective cohort study , emergency medicine , intensive care medicine , lung
Background. Up to 32% of patients with COVID-19 pneumonia may require intensive care unit (ICU) admission or mechanical ventilation. Data from low- and middle-income countries on COVID-19 acute respiratory distress syndrome (ARDS) are limited. Groote Schuur Hospital in Cape Town, South Africa, expanded its intensive care service to support patients with COVID-19 ARDS requiring invasive mechanical ventilation (IMV). Objectives. To report on patients’ characteristics and outcomes from the first two pandemic waves. Methods. All patients with COVID-19 ARDS admitted to the ICU for IMV were included in this prospective cohort study. Data were collected from 5 April 2020 to 5 April 2021. Results. Over the 12-month study period, 461 patients were admitted to the designated COVID-19 ICU. Of these, 380 met the study criteria and 377 had confirmed hospital discharge outcomes. The median (range) age of patients was 51 (17 - 71) years, 50.5% were female, and the median (interquartile range (IQR)) body mass index was 32 (28 - 38) kg/m2. The median (IQR) arterial oxygen partial pressure to fractional inspired oxygen (P/F) ratio was 97 (71 - 128) after IMV was initiated. Comorbidities included diabetes (47.6%), hypertension (46.3%) and HIV infection (10.5%). Of the patients admitted, 30.8% survived to hospital discharge with a median (IQR) ICU length of stay of 19.5 (9 - 36) days. Predictors of mortality after adjusting for confounders were male sex (odds ratio (OR) 1.74), increasing age (OR 1.04) and higher Sequential Organ Failure Assessment (SOFA) score (OR 1.29). Conclusions. In a resource-limited environment, the provision of IMV support in the ICU achieved 30.8% hospital survival in patients with COVID-19 ARDS. The ability to predict survival remains difficult given this complex disease.