目的:评估重症监护病房(ICU)床位占用(主要)是否增加了医院压力,使用中的呼吸机和急诊科(ED)溢出-与在三角洲之前的科罗拉多州ICU中降低COVID-19ICU患者生存率有关,Delta和Omicron变体。
方法:使用离散时间生存模型的回顾性队列研究,与广义估计方程拟合。
方法:科罗拉多州的34个医院系统,美国,在COVID-19大流行期间,患者容量最高的ICU。
方法:科罗拉多州医院的9196名非儿科SARS-CoV-2患者于2020年8月1日至2022年3月1日期间入院ICU,随访28天。
方法:死亡或出院到临终关怀。
结果:对于科罗拉多州的Delta时代COVID-19ICU患者,据估计,在入住ICU的患者每天都会暴露在经历其第75个百分位数的ICU饱满度或以上的设施中,患者的死亡几率会增加26%。与未暴露天数的患者相比(OR:1.26;95%CI:1.04至1.54;p=0.0102),调整年龄,性别,ICU住院时间,疫苗接种状况和医院质量评级。对于Delta时代和Omicron时代的患者来说,我们还发现,与高呼吸机使用率和(在一部分设施中)ED溢出状态相关的死亡危险显著增加.对于三角洲前期患者,我们估计了相同饱腹度暴露的相对无效甚至保护作用,这提供了一个有意义的对比,以前的研究发现增加的危害,但仅限于前三角洲研究窗口。
结论:总体而言,尤其是在三角洲时代(当时大多数科罗拉多州的设施都很完整),在COVID-19ICU患者中,更全面的医院暴露量增加与死亡风险增加相关.
OBJECTIVE: To assess whether increasing levels of hospital stress-measured by intensive care unit (ICU) bed occupancy (primary), ventilators in use and emergency department (ED) overflow-were associated with decreasing COVID-19 ICU patient survival in
Colorado ICUs during the pre-Delta, Delta and Omicron variant eras.
METHODS: A retrospective cohort study using discrete-time survival models, fit with generalised estimating equations.
METHODS: 34 hospital systems in
Colorado, USA, with the highest patient volume ICUs during the COVID-19 pandemic.
METHODS: 9196 non-paediatric SARS-CoV-2 patients in
Colorado hospitals admitted once to an ICU between 1 August 2020 and 1 March 2022 and followed for 28 days.
METHODS: Death or discharge to hospice.
RESULTS: For Delta-era COVID-19 ICU patients in
Colorado, the odds of death were estimated to be 26% greater for patients exposed every day of their ICU admission to a facility experiencing its all-era 75th percentile ICU fullness or above, versus patients exposed for none of their days (OR: 1.26; 95% CI: 1.04 to 1.54; p=0.0102), adjusting for age, sex, length of ICU stay, vaccination status and hospital quality rating. For both Delta-era and Omicron-era patients, we also detected significantly increased mortality hazard associated with high ventilator utilisation rates and (in a subset of facilities) states of ED overflow. For pre-Delta-era patients, we estimated relatively null or even protective effects for the same fullness exposures, something which provides a meaningful contrast to previous studies that found increased hazards but were limited to pre-Delta study windows.
CONCLUSIONS: Overall, and especially during the Delta era (when most
Colorado facilities were at their fullest), increasing exposure to a fuller hospital was associated with an increasing mortality hazard for COVID-19 ICU patients.