Massimiliano Greco, Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy,,IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
Thomas De Corte, Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium, Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
Ari Ercole, Cambridge Centre for Artificial Intelligence in Medicine, University of Cambridge, Cambridge, UK.,, University of Cambridge Division of Anaesthesia, Addenbrooke's Hospital, Hills Road, Cambridge, UK
Massiomo Antonelli, Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy.,Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
Elie Azoulay, Médecine Intensive et Réanimation, APHP, Saint-Louis Hospital, Paris University, Paris, France,Université de Paris, Paris, France
Giuseppe Citerio, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,,Department Neuroscience, Neurointensive Care, ASST-Monza, Monza, Italy
Andy Conway Morris, Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK., Division of Immunology, Department of Pathology, University of Cambridge, Cambridge, UK., JVF Intensive Care Unit, Addenbrookes Hospital, Cambridge, UK
Gennaro De Pascale, Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy, , Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
Frentisek Duska, Department of Anaesthesia and Intensive Care, Third Faculty of Medicine, Charles University, Prague, Czech Republic, FNKV University Hospital in Prague, Prague, Czech Republic
Paul Ebers, Department of Intensive Care Medicine, Laboratory of Critical Care Computational Intelligence, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
Sharon Einav, General Intensive Care Unit of the Shaare Zedek Medical Center, Jerusalem, Israel,Faculty of Medicine, Hebrew University, Jerusalem, Israel
Lui Forni, Department of Critical Care, Royal Surrey Hospital and Faculty of Experimental Medicine, University of Surrey, Guildford, UK
Laura Galarza, Intensive Care Unit, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
Armand R J Girbes, Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Sciences (ACS), Amsterdam Infection and Immunity Institute (AI&II), UMC, Location VUmc, VU Amsterdam, Amsterdam, The Netherlands.
GIacomo Grasselli, Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy., Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
Vitaly Gusarov, Pirogov National Medical and Surgical Center, Moscow, 105203, Russian Federation
Alasdair Jubb, Division of Anaesthesia, University of Cambridge Department of Medicine, Cambridge, UK, Neurosciences and Trauma Critical Care Unit, Cambridge University Hospitals, Cambridge, UK, Cancer Research UK-Cambridge Institute, Cambridge, UK
Jozef Kesecioglu, Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
Andrea Lavinio, Neurosciences and Trauma Critical Care Unit (NCCU), Anaesthesia Medical Examiner and Clinical Lead Organ Donation-Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
Maria Cruz Martin Delgado, Intensive Care Unit, Hospital Universitario de Torrejón, Madrid, Spain, ,Universidad Francisco de Vitoria, Madrid, Spain
Johannes Mellinghoff, School of Sports and Health Sciences, University of Brighton, Brighton, UK
Sheila Nainan Myatra, Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
Marlies Ostermann, Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK
Marieangela Pellegrini, ntensive Care Unit, AnOpIVA, Akademiska sjukhuset, Uppsala, Sweden,ntensive Care Unit, AnOpIVA, Akademiska sjukhuset, Uppsala, Sweden
Pedro Povoa, , JVF Intensive Care Unit, Addenbrookes Hospital, Cambridge, UKPolyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal, , Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark.
Stefan Schaller, Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,School of Medicine, Klinikum rechts der Isar, Department of Anesthesiology and Intensive Care, Technical University of Munich, Munich, Germany
Jean-Louis Teboul, Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, AP-HP Université Paris-Saclay, Inserm UMR S_999, Le Kremlin-Bicêtre, France
Adrian Wong, Department of Critical Care, King's College Hospital, London, UK
Jan J. De Waele, Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. Jan.DeWaele@UGent.be., Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. Jan.DeWaele@UGent.be.
Maurizio Cecconi, Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy, , IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
Esicm Unite-COVID investigators

Document Type

Article

Publication Date

6-2022

Abstract

Purpose: To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients.

Methods: Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020.

Results: 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%-50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors.

Conclusions: ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality.

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