Comparison of clinical course and outcomes of critically ill patients with SARS-CoV2 infection managed in traditional ICU and “Flex” ICU during the surge of the pandemic in the Bronx

  1. Victor Perez Gutierrez
  2. Alex Carlos
  3. Jessica Nino
  4. Julieta Osella
  5. Vihren Dimitrov
  6. Moiz Kasubhai
  7. Vidya Menon

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Abstract

BACKGROUND

As part of the response to increase critical care capacity during the unprecedented surge of COVID-19 infections, NYC Health + Hospital systems identified and resourced areas in the hospital that could deliver critical care as “Flex” ICUs to complement the traditional ICUs to manage the rapid influx of critically ill patients.

OBJECTIVE

Comparison of clinical features and outcomes of mechanically ventilated COVID-19 patients admitted to the traditional and “Flex” ICUs during the surge of the pandemic

METHODS

Retrospective comparative cohort study of patients with confirmed SARS-CoV-2 infection on mechanical ventilation admitted to traditional ICU and ‘Flex’ ICU. Univariate and multivariate analysis to detect factors associated with death from COVID-19 patients in mechanical ventilation were performed with the Cox proportional hazards regression model

RESULTS

Out of the 312 patients on mechanical ventilation, 111 were admitted to the traditional ICU and 201 to the ‘Flex’ ICU. The mortality rate was higher in the ‘Flex’ ICU compared with the traditional ICU, but the adjusted risk model was not significantly associated with increased mortality

CONCLUSION

“ Flex” ICUs played a crucial role in the management of critically ill patients during the pandemic. Mortality risk of patients in the “Flex” ICUs were comparable to traditional ICUs in the adjusted analysis. While there is enough evidence for Intensivist managed ICUs to have better outcomes, our study demonstrates the feasibility of non-intensivist led Flex” ICUs during a crisis.

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    SciScore for 10.1101/2021.03.03.21252868: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The Institutional Review Board approved the study (IRB #20-007).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data were analyzed using SPSS 26 (SPSS, Inc, Chicago, Ill).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.03.03.21252868v1 on medRxiv