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ICU COVID-19 mortality rate drops

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Editor’s Note: Find the latest Medscape COVID-19 news and guidance Coronavirus Resource Center..

According to a systematic review, the overall mortality rate of COVID-19 patients in intensive care units (ICUs) across Europe, Asia and North America has dropped from close to 60% at the end of March to close to 42% at the end of May. I will. Meta analysis.

A study by RA Armstrong, a fellow at Severn Deanery in Bristol, England, and his colleagues Published online July 15 anesthesia.. This is the first systematic review and meta-analysis of COVID-19 patient outcomes in the ICU.

Armstrong et al. searched the MEDLINE, EMBASE, PubMed, and Cochrane databases for studies up to May that reported ICU mortality in adult patients hospitalized for COVID-19. The primary outcome measure was ICU mortality as a percentage of completed ICU hospitalizations.

They found 24 relevant observational studies involving 10,150 patients. They calculated that the total ICU mortality in all studies was 41.6%, a decrease of about one-third by the end of March from the 59.5% ICU mortality seen in the study.

The authors note that the lower mortality rate is nearly double the 22% mortality rate seen in other ICU hospitalizations for viral pneumonia. They note that mortality rates do not differ significantly between the three continents.

“Real-time information sharing”

Amesh A. Adalja, MD, MD, an infectious disease and emergency medicine physician and senior scholar at the Johns Hopkins Health and Safety Center in Baltimore, Maryland, Medscape Medical News The news reflects other information on the scene.

“It’s clear that in July 2020, we know a lot more about this virus, the complications it can cause, and how to prevent those complications, than it did in March 2020,” he said. Said. “We are also far better at using other devices such as high flow nasal cannulas to reflexively use the ventilator to manage a patient’s oxygen needs.”

He also said more treatments such as lemdecivir are currently available. Remdecibir has not been shown to reduce mortality in clinical trials, but it has been shown to be beneficial in accelerating withdrawal from ICU.

“We’re diagnosing these patients faster so they can intervene faster. We’re learning about cytokine storms and the drugs available against them,” he said. He said people may be infected with low viral load because of social distance.

It was important to track patients to make sure that the decline was not only temporary, and that people were not leaving the ICU just because they died months later.

He wasn’t surprised that the results were virtually the same across the continent, he said.

“We’re learning from each other because we’re all in the same team caring for these patients and everyone shares information in real time,” he continued.

The virus is not so deadly

The results give hope, but Adalja added: “I don’t say the virus is now deadly. It still has the ability to kill it. It still has the ability to disrupt hospitals and the entire health care system.

“We’re getting better at dealing with it, but it still carries significant mortality, and we shouldn’t be satisfied with the levels from this study. We want to make it as low as possible And I want to stop people from even needing ICU.”

Tim Cook, co-author of a study at MBBS, a consultant for anesthesia and intensive care medicine at Royal United Hospital in Bath, England, said: Medscape Medical News Researchers have had limitations on how to report research results.

“We can’t really determine what the admission criteria for ICU care were,” he added.

“I don’t know if all patients in different studies had similar baseline characteristics and baseline health, were also ill when they were admitted to the ICU, or the intervention and treatment they received,” he said. He said.

This underscored the need for more structured reporting globally, he continued.

According to Cook, in March and April, many medical systems are likely to be overwhelmed by cases, possibly only due to the most morbidly admitted to the ICU. That is. This helps explain the degradation over time.

“It’s also plausible-but unproven-it wasn’t possible to maintain the same standard of care as usual, which greatly extended the system and reduced survival,” he explained.

But advances in knowledge are undeniable, Cook said, COVID-19 involves affecting many organs and systems of the body, leaving patients dehydrated, requiring more fluid, Non-invasive ventilation It may play a role, and its prone position may improve lung function. In addition, strategies have been developed to reduce the rate of coagulation.

He says there are signs that the mortality rate will continue to improve, including due to the use of promising therapies including steroids DexamethasoneShown in Save lives, Especially among the most ill patients with COVID-19. However, drug use in the United States Mixed..

The author and Adalja do not disclose the financial relationship involved.

anesthesia. Published July 15, 2020 Online. Full text

Marcia Frellick is a freelance journalist based in Chicago. She has previously contributed to the Chicago Tribune and Nurse.com and was the editor of the Chicago Sun Times, Cincinnati Enquirer and The St Cloud (Minnesota) Times. Follow her on Twitter @mfrellick ..

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