Presentation, characteristics, treatments and outcomes of mechanically ventilated patients with COVID-19 in Bulgaria

  1. Neda Bakalova
  2. Ivats Natsev
  3. Hristo Damov
  4. Irina Yatsenko
  5. Stefanija Jovinska
  6. Rostislav Enev
  7. Mihail Cholakov
  8. Filip Abedinov
  9. Denitza Kalendjieva

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Abstract

Background

The first surge of coronavirus disease 2019 (COVID-19) cases in Bulgaria occurred in the fall of 2020. Here we describe the clinical presentation, patient characteristics, treatments and outcomes of mechanically ventilated COVID-19 patients in a newly formed COVID-19 ICU at a tertiary cardiac center in Sofia, Bulgaria.

Methods

This is a retrospective observational study of mechanically ventilated COVID-19 patients admitted to Sveta Ekaterina University Hospital in Sofia, Bulgaria, between November 4th, 2020 and January 6th, 2021. Data were collected from electronic and written patient records and charts.

Results

We identified 38 critical care patients admitted with respiratory failure and treated with mechanical ventilation at our COVID-19 ICU during this period. The median age was 66 (IQR 57-76, range 27-89) and 74% were male. Most patients, 36 (95%), had at least one comorbidity. The most common comorbidities were hypertension, valvular heart disease, ischemic heart disease and diabetes mellitus. Overall, 27 (71%) patients had a concomitant cardiac disease other than hypertension and 24% were recent cardiac surgical patients. Inotropic support was required in 29 (76%) patients, renal replacement therapy in 12 (32%) patients and prone positioning and ECMO were used in 5 (13%) and 2 (5%) patients respectively. The median duration of mechanical ventilation was 7.5 (IQR 5-14) days overall and 9 (IQR 6-13) days for survivors. At 30-days 28 (74%) of patients had died. Overall, 32 (84%) patients died in hospital and only 6 (16%) patients were discharged home.

Conclusions

During the first major surge of COVID-19 cases in Bulgaria, despite the wave arriving later than in other countries, the healthcare system was largely unprepared. In our setting, mortality in mechanically ventilated patients was very high at 84%. Several factors might have contributed to these results, namely the predominance of cardiovascular comorbidities in our patient population, the strained ICU capacity and the lack of medical personnel.

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  1. ScreenIT

    SciScore for 10.1101/2021.12.17.21267655: (What is this?)

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

    Table 1: Rigor

    EthicsConsent: Given the retrospective nature of the study and the use of deidentified patient data, the need for individual informed consent was waived by the hospital’s ethics committee.
    IRB: Given the retrospective nature of the study and the use of deidentified patient data, the need for individual informed consent was waived by the hospital’s ethics committee.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    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: We detected the following sentences addressing limitations in the study:
    Limitations: Our study has several important limitations. First, it is a single center observational study and all assumptions for a causal link between strained capacity, inadequate staffing, and poor outcomes are strictly theoretical and cannot be firmly established. Our study sample was small in size and our patient population was with an unusually high rate of cardiovascular comorbidities which might have led to a worse survival.

    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.
    • Thank you for including a protocol registration statement.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2021.12.17.21267655v2 on medRxiv
  3. Version published to 10.1101/2021.12.17.21267655v1 on medRxiv