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- Title
O que mudou entre os períodos de pico e de platô durante a primeira onda do SARS-CoV-2? Estudo multicêntrico português em unidades de cuidados intensivos.
- Authors
Antunes Pereira, Rui; Sousa, Marta; Pedro Cidade, José; Melo, Luís; Lopes, Diogo; Ventura, Sara; Aragão, Irene; de Freitas Lima Neto, Raul Miguel; Molinos, Elena; Marques, Ana; Cardoso, Nelson; Marino, Flávio; Brás Monteiro, Filipa; Pinho Oliveira, Ana; C. Silva, Rogério; Neto Real, André Miguel; Sarmento Banheiro, Bruno; Reis, Renato; Adão-Serrano, Maria; Cracium, Ana
- Abstract
Objective: To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. Methods: This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. Results: Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39; p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136; p = 0.6), antibiotic therapy (57% versus 64%; p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%; p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5]; p = 0.002) and presented a higher use of vasopressors (47% versus 36%; p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%; p < 0.001) at admission, prone positioning (45% versus 36%; p = 0.04), and hydroxychloroquine (59% versus 10%; p < 0.001) and lopinavir/ritonavir (41% versus 10%; p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%; p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. Conclusion: There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave.
- Subjects
CRITICAL care medicine; COVID-19 pandemic; ADRENOCORTICAL hormones
- Publication
Revista Brasileira de Terapia Intensiva, 2022, Vol 34, Issue 4, p433
- ISSN
0103-507X
- Publication type
Article
- DOI
10.5935/0103-507x.20210037-pt