Analysis of global studies published in Anesthesia (journal of the Society of Anesthetists) shows that the morale of intensive care from COVID-19 has been declining since the onset of pandemic, but development is slowing and may have slowed. onwards. The study is by Professor Tim Cook (Consultant in Anesthesia and Intensive Care Medicine, NHS Foundation Trust Royal Hospitals Bath, Bath, UK, and Honorary Professor, School of Medicine, University of Bristol, UK) and colleagues.
A previous meta-analysis * by Cook and colleagues, published in July, 2020, concluded that the overall mortality of COVID-19 patients in intensive care units (ICUs) has fallen from nearly 60% at the end of March 2020 to 42% at the end of May 2020 – a relative reduction of about a third. This new study shows that, in studies up to October, 2020, ICU mortality has fallen again to 36%. So, while the situation is still improving, the pace of progress has slowed significantly.
In this study, the authors used data from 52 observational studies involving 43,128 patients, and, in addition to studies from Europe, North America and China that were included in the re- Earlier judgment, this study included initial reports from the Middle East, South Asia. and Australia, as well as four new national or regional records.
The authors explain that, in recent months, several studies have clarified which treatments do and do not confer an advantage in ICU administration of COVID-19. Steroids (especially dexamethasone) were shown to survive in early June in oxygen-dependent or mechanically-assisted patients, while other drugs include hydroxychloroquine, azithromycin, lopinavir / ritonavir and remdesivir have shown no obvious mortality benefit. They also note that the administration of COVID-19 appears to have improved over the year with changes in approaches to oxygen therapy, fluid therapy and bleeding management.
The data show that the ICU mortality rate from COVID-19 is 30-40% in most geographical areas. There are two geographical areas outside these boundaries and they are statistically distinct from other geographical regions. One registration report from Victoria State in Australia (home city of Melbourne) reports a very low mortality of 11%. In the Middle East, on the other hand, mortality from a study involving four countries is high at 62%. There are several possible explanations for this finding, including that studies from the Middle East included patients early in the pandemic when mortality was higher, while the patients admitted in Australia were later when mortality was lower.
The authors state that the analysis is limited by the lack of global consistency on what constitutes intensive care, admission criteria for patients, basic health characteristics of admitted patients and so on. the severity of an emergency illness, or reporting on the nature or intensity of treatments. It can therefore be difficult to compare studies from different sectors.
The authors say: “Our analysis includes studies published just up to October 2020. Since then, a number of variable viruses have emerged and in some countries on the path of the pandemic turn through December 2020 and into January 2021. This has increased the demand for ICUs in these areas and will merit further analysis over time. To counter this, the vaccine is now available in many countries and we can hope that this will also, over a number of months, have a positive effect on the spread path and demand for ICU care. “
They conclude: “After our first meta-analysis last year showed a significant reduction in ICU mortality from COVID-19 from March to May 2020, this updated analysis shows that there is a likelihood that any fall in mortality rate between June and October 2020 has been flat or flat. . ”
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