New research reveals that the mortality rate of COVID-19 intensive care (ICU) in Sweden was lower in the first wave of pandemic than in many studies from other countries. And while an analysis of individual baseline conditions found that they were linked to mortality, a study that looked at all of these variables together found that COVID-19 mortality in intensive care was not tied to baseline conditions, but except chronic lung disease. However, this new study, like a previous study, found that mortality was driven by age, the severity of COVID-19 infection and the presence and rate of organ failure.
The study is published in the European Journal of Anaesthesiology (official journal of the European Society of Anaesthesiology and Intensive Care [ESAIC]) and is owned by Dr. Michelle Chew, Linkoping University Hospital, Linkoping, Sweden, and colleagues.
“Coupled with what is widely seen as a‘ calm ’national pandemic strategy, outcomes for ICU care in Sweden are easily monitored,” the authors explained.
They analyzed 1563 adult admissions to Swedish ICUs from March 6 to May 6, 2020 with laboratory-confirmed COVID-19 infection, and completed 30-day follow-up work, and found 30-day mortality for 27%, and ICU intra – mortality was 23%, indicating that the majority of patients who died after needing ICU treatment died within ICU.
A number of factors included age-related mortality. Being male raised the risk of death by 50%, while with severe respiratory failure (more advanced disease – represented in three-quarters of patients) reduced the risk of death. However, with the exception of chronic lung disease (50% greater risk of death), the presence of comorbidities was not independently associated with mortality. Also to note, was that the level of hypoxia (sufficient oxygen) was much higher in this Swedish group than those from other countries. Put another way, these Swedish patients were usually sick when they were admitted to ICU.
ICU mortality in this Swedish study has a 23% mortality between those found in two nationwide studies with small groups from Iceland and Denmark, at 15% and 37% respectively. It is lower than the mortality rate reported from the North American study (35%) and the French-Belgian-Swiss study (26-30%). These studies had almost complete dissection data, meaning that the majority of patients survived and left ICU or sadly died there, with very few patients still on the line. treatment at the time of the examination.
In one report from Lombardy, Italy, ICU mortality was reported at 26%; but this did not include complete data as many patients were still being treated. A later study consisted mainly of the same patients and with an almost complete ICU follow-up, mortality was 49%. These results compare with a recent meta-analysis of 20 studies worldwide (TM Cook and colleagues, Anesthesia, 2020) that reported an ICU mortality of 42% for patients with completed ICU admissions and transmission data. Another study by Cook and colleagues, published in Anesthesia at the same time as this Swedish study (see separate press release) shows global ICU mortality up to October 2020 has since fallen further into 36%.
This new study from Sweden confirms previous conclusions that mortality rates are significantly higher among those aged 65 years and older. Patients over the age of 80 were seven times more likely to die than those aged 50 and under, although the authors make it clear that their data “show that intensive care provision should not be restricted by age only ”. They say: “Not everyone over the age of 80 dies in an ICU, which is one reason why we cannot exclude this group of patients from age – based ICU care. -All decisions about care must be made on a patient-to-patient basis “.
As in other studies, the majority of patients suffered from underlying conditions (comorbidities), usually high blood pressure, diabetes, and obesity. Although most abilities were death-related when studied separately, their effects were not statistically significant after adjustment for other variables. Obesity (BMI> 40) was not associated with increased mortality as suggested by other studies. The only underlying condition found to affect Swedish patients was chronic lung disease, which was associated with a 50% greater risk of death.
The authors discuss the various aspects of Swedish ICU policy that may be linked to a lower ICU mortality rate. They say: “We believe that process and organizational factors have contributed to the relatively good results seen in Swedish ICUs such as personnel, protective equipment, access to drugs, medical and technical equipment are considered at an early stage at hospital and departmental levels. “
In the first quarter of 2020 there were 5.1 ICU beds in Sweden per 100,000 population, compared to 27 / 100,000 in the US. The COVID-19 pandemic spread a coordinated response in Swedish ICUs doubling the number of beds from around 500 to over 1100 at the highest level. The proportion of residential ICU beds in the country during the study period (the peak months of the first wave of pandemic) did not reach maximum capacity. Other factors that may be associated with lower ICU COVID-19 mortality are the combined anesthesiology and intensive care of specialists in Sweden, and this dual capability allowed rapid proliferation of resources from perioperative care to intensive care management. .
However, Sweden’s strategy has been to face harsh criticism at home and abroad for being too lenient and reliant on the individual responsibility of citizens rather than enforcing locksmiths. The King of Sweden also publicly condemned, at the end of 2020, the country’s COVID-19 strategy as a failure. New laws on public transport and gatherings were implemented in autumn 2020 to prevent the spread of SARS-CoV-2 surges, and at the end of 2020, the Swedish Government introduced new laws to make restrictions possible. such as enforcing center closures to prevent disruption. raging out of control. Future staff shortages, burn capacity and a number of organizational challenges remain.
The authors conclude: “Mortality rates in COVID-19 patients admitted to Swedish intensive care units are generally lower than reported in other countries despite disease exacerbated when they were introduced among Swedish patients. Mortality appears to be driven by age, depth of baseline disease, and the presence and rate of organ failure, rather than pre-existing comorbidities. “
Professor Chew, who is also the deputy editor of the European Journal of Anaesthesiology, adds: “Although Sweden chose a different dispersal strategy for its European neighbors, their population had not been immune to rising disease rates this winter. time to determine whether the Swedish health care system can sustain the long – term burden of COVID – 19 disease. ”
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