COVID-19 ICU and mechanical ventilation patient characteristics and outcomes—A systematic review and meta-analysis

Raymond Chang, Khaled Mossad Elhusseiny, Yu-Chang Yeh and Wei-Zen Sun

PLOS ONE, 2021, vol. 16, issue 2, 1-16

Abstract: Background: Insight into COVID-19 intensive care unit (ICU) patient characteristics, rates and risks of invasive mechanical ventilation (IMV) and associated outcomes as well as any regional discrepancies is critical in this pandemic for individual case management and overall resource planning. Methods and findings: Electronic searches were performed for reports through May 1 2020 and reports on COVID-19 ICU admissions and outcomes were included using predefined search terms. Relevant data was subsequently extracted and pooled using fixed or random effects meta-analysis depending on heterogeneity. Study quality was assessed by the NIH tool and heterogeneity was assessed by I2 and Q tests. Baseline patient characteristics, ICU and IMV outcomes were pooled and meta-analyzed. Pooled odds ratios (pOR) were calculated for clinical features against ICU, IMV mortality. Subgroup analysis was carried out based on patient regions. A total of twenty-eight studies comprising 12,437 COVID-19 ICU admissions from seven countries were meta-analyzed. Pooled ICU admission rate was 21% [95% CI 0.12–0.34] and 69% of cases needed IMV [95% CI 0.61–0.75]. ICU and IMV mortality were 28.3% [95% CI 0.25–0.32], 43% [95% CI 0.29–0.58] and ICU, IMV duration was 7.78 [95% CI 6.99–8.63] and 10.12 [95% CI 7.08–13.16] days respectively. Besides confirming the significance of comorbidities and clinical findings of COVID-19 previously reported, we found the major correlates with ICU mortality were IMV [pOR 16.46, 95% CI 4.37–61.96], acute kidney injury (AKI) [pOR 12.47, 95% CI 1.52–102.7], and acute respiratory distress syndrome (ARDS) [pOR 6.52, 95% CI 2.66–16.01]. Subgroup analyses confirm significant regional discrepancies in outcomes. Conclusions: This is a comprehensive systematic review and meta-analysis of COVID-19 ICU and IMV cases and associated outcomes. The significant association of AKI, ARDS and IMV with mortality has implications for ICU resource planning for AKI and ARDS as well as suggesting the need for further research into optimal ventilation strategies for COVID-19 patients in the ICU setting. Regional differences in outcome implies a need to develop region specific protocols for ventilatory support as well as overall treatment.

Date: 2021
References: View complete reference list from CitEc
Citations:

Downloads: (external link)
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246318 (text/html)
https://journals.plos.org/plosone/article/file?id= ... 46318&type=printable (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0246318

DOI: 10.1371/journal.pone.0246318

Access Statistics for this article

More articles in PLOS ONE from Public Library of Science
Bibliographic data for series maintained by plosone ().