Doctors getting measure of their adversary steadily reduce death rate in intensive care
Global review suggests knowledge gained over the course of pandemic has helped save patients’ lives
‘There was a lot of discussion and changes in treatment in the first month when patients came to ICU in droves’
DEATH rates in patients in intensive care units have declined rapidly over the course of the pandemic, a review of studies across the world has found, with the authors suggesting that as the pandemic has progressed, treatment has improved.
The review of 24 studies covering more than 10,000 patients in Europe, Asia and North America found that mortality fell by almost a third in just two months.
Almost 60 per cent of patients in ICU died at the end of March, compared with 42 per cent at the end of May, the study, published in the journal Anaesthesia, found. However, this is still higher than in ICU patients with other viral pneumonias, such as influenza, where the death rate is 22 per cent.
This higher death rate in Covid-19 patients could be because of the dis- ease itself or the difficulty in providing reliable services during a pandemic, the authors said.
The largest study in the review came from the UK’S Intensive Care National Audit and Research Centre, which included more than 8,000 patients from England, Wales and Northern Ireland.
The researchers conducted a sensitivity analysis, removing the UK figures to check whether they were skewing the results. But even without the ICNARC data, the results were the same across the globe.
There are, say the authors, several explanations for the improved death rates: “It may reflect the rapid learning that has taken place on a global scale due to the prompt publication of clinical reports early in the pandemic.
“It may also be that ICU admission criteria have changed over time, for example, with greater pressure on ICUS early in the pandemic surge.”
Prof Tim Cook, lead author and a consultant in anaesthesia and intensive care at Royal United Hospitals Bath and the University of Bristol, told The Daily Telegraph the data reflected the day-today experience of front-line clinicians.
“The study not only stands up statis- tically, but reflects what people were
saying at the time of the surge in patients in late March and early April,” he said. “Things were very difficult, and people were struck by a disease they didn’t understand.
“China did a fabulous job of publishing papers and providing information on critical illness, but patients had blood clots, patients were being turned over. All these things were new to the ICU community. There was a lot of discussion, re-evaluation and changes in treatment in the first month when patients came to ICU in droves.”
Separate data from China early on in the pandemic also showed that mortalcovid-19
ity rates improved over time. The authors said the findings were also likely to reflect the fact that long ICU stays, for example, due to slow weaning from a ventilator, take time to be reflected in the data.
Critical illness associated with Covid-19 can last for long periods, with approximately 20 per cent of UK ICU admissions lasting more than 28 days, and 9 per cent more than 42 days.
The authors wrote: “The important message, however, is that as the pandemic has progressed and all these factors combine, survival of patients admitted to intensive care units with
has significantly improved.” The ICU mortality did not differ significantly across continents despite some evidence of variations in admission criteria and treatments delivered.
The researchers also said that the recent finding that the steroid dexamethasone reduced death rates by a third among patients on ventilators could also lead to even better outcomes for patients in ICU.
“Everyone who is critically ill will get dexamethasone as part of their treatment” said Prof Cook. “It’s a really effective treatment, and I would hope that mortality comes down further,”