by Savel, Richard H.; Shiloh, Ariel L.; Saunders, Paul C.;
Kupfer, Yizhak
Critical Care
Medicine: September
2020 - Volume 48 - Issue 9 - p 1398-1400
In this issue of Critical Care Medicine, Auld et al (1)
present some important data regarding ICU and hospital mortality of
critically ill patients with coronavirus disease 2019 (COVID-19). Focusing on
these results for their mechanically ventilated (MV) patients, we would begin
by stating that their study was able to account for 147 of 165 or 89% of the
patients, meaning that only 18 patients (11%) remained in hospital (ICU or
otherwise) to potentially change the mortality results. This fact
alone allows us to place significant weight in their results.
In terms of more detail, for patients on MV, ICU mortality was
33.9% (56/165), while their hospital mortality was similar at 35.8%
(59/165). This is in dramatic contrast to recent studies demonstrating
significantly higher mortality related to MV in COVID patients (2–4).
Although there are multiple reasons as to why ICU and hospital mortality of
MV patients is lower than that which has been reported in other COVID
literature, we believe these are the key sentences of their article: “During
the study period, ICU capacity enabled the timely admission of all patients requiring
critical care to a COVID-ICU. Further, all patients admitted to a COVID-ICU
were cared for by a traditional ICU care team led by a critical care-trained
attending physician with standard (i.e., pre-COVID) ICU staffing ratios. There
were no critical shortages in medications, ventilators, dialysis machines, or
other critical care equipment.” Their medical system was not overwhelmed. The
standard of care that was applied did not change, and it was not a mass
casualty situation such as happened in other part of the world where ICU
capacity needed to increase by a factor of three or greater. What are some of
the relevant points to be raised?
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