March 23, 2021

How System-Wide Strategies Early in the COVID-19 Pandemic Improved ICU Outcomes

First study in the U.S. to compare COVID-19 outcomes with other ICU admissions

650×450-Covid-ICU-Outcomes

“These are the situations when you would rather overprepare,” says Peng Zhang, MD, a critical care physician in Cleveland Clinic’s Respiratory Institute. She was nearing the end of her fellowship around the time the coronavirus began circulating in the U.S.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Dr. Zhang, now an attending physician, along with Abhijit Duggal, MD, and Hassan Khouli, MD, Chair of the Department of Critical Care Medicine, set out to compare the clinical outcomes of ICU patients — both with COVID-19 and without — early in the pandemic. They published their findings in CHEST.

The study shows that the ICU and hospital mortality rates of patients with COVID-19 were significantly higher than non-COVID patients in March 2020 (both P < .001). However, by June 2020, there was no statistical difference (both P = .16) between the two cohorts. This was also true for hospital deaths, ICU length of stay, hospital length of stay and mechanical ventilation duration in the COVID-19 cohort. Meanwhile, ICU outcomes for the non-COVID-19 cohort remained relatively unchanged, according to the authors.

The authors acknowledge that the utilization of pharmacological interventions, like remdesivir and corticosteroids, may have helped improve clinical outcomes but alone are not attributable to the significant overall improvement in mortality rates.

Dr. Zhang explains that the improvement demonstrated in this study is greater than what has been documented in the literature about the effects of corticosteroids. And remdesivir is not associated with mortality reduction, according to a large study sponsored by the Hassan Khouli, MD

Advertisement

Cleveland Clinic: Key COVID-19 strategies

She notes that findings from their study are encouraging and not entirely surprising, but it’s still complicated. Adding to this, Dr. Khouli remarks, “The comparison to non-COVID ICU patients is complex since there are no risk-adjusted equations for COVID-19 now.” However, the authors are confident that several key strategies played a pivotal role in improving outcomes.

They outline the following system-wise strategies:

  • Designation of cohort COVID-19 ICU in hubs across the healthcare system.
  • Careful evaluation of ICU occupancy and a plan to manage and redistribute caseloads if needed.
  • Deployment of COVID-19 specific training modules for all ICU providers.
  • Standardized and evidence-based management of ICU care for patients with COVID-19.
  • Collaboration across multidisciplinary teams, including critical care, infectious disease, nephrology and palliative care.

“To our knowledge, this is the first large case series to show continuous improvement in clinical outcomes for critically ill COVID-19 patients,” says Dr. Zhang. The authors are hopeful that in the face of another epidemic or pandemic, healthcare systems can readjust nimbly to meet the needs of patients.

She concludes, “For healthcare systems that are adequately resourced and prepared, system-wide strategies that are implemented early can be incredibly effective in improving outcomes.”

Advertisement

Editor’s note: Gretchen L. Sacha, PharmD (Department of Pharmacy); Joseph Keller, PA-C, MHS (Department of Critical Care Medicine); and Lori Griffiths, MPH, RN (Department of Quality and Patient Safety) are co-authors on this study.

Related Articles

Stellate Ganglion Block
May 17, 2023
Nerve Block Shows Promise for Long COVID-Related Olfactory or Gustatory Dysfunction

Patients report improved sense of smell and taste

Covid image
April 26, 2023
What Long COVID Means for Rheumatologists (Video)

Clinicians who are accustomed to uncertainty can do well by patients

Covid related skin effects
April 4, 2023
Cutaneous Manifestations of COVID-19 in Special Populations

Unique skin changes can occur after infection or vaccine

Glucometer
February 10, 2023
Effects of COVID-19 on Blood Sugar and Type 2 Diabetes

Cleveland Clinic analysis suggests that obtaining care for the virus might reveal a previously undiagnosed condition

covid-19
January 13, 2023
Optimal Management of High Risk Immunocompromised Patients in the COVID-19 Era

As the pandemic evolves, rheumatologists must continue to be mindful of most vulnerable patients

covid-19 virus
January 12, 2023
Real World Experience with Tixagevimab/Cilgavimab in B-Cell-Depleted Patients

Early results suggest positive outcomes from COVID-19 PrEP treatment

Eosinophilic Fasciitis
November 29, 2022
New Onset Eosinophilic Fasciitis after COVID-19 Infection

Could the virus have caused the condition or triggered previously undiagnosed disease?

COVID-19 and rash
June 16, 2022
Common Skin Signs of COVID-19 in Adults: An Update

Five categories of cutaneous abnormalities are associated with COVID-19

Ad