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. 2022 Jan 13;12(1):5.
doi: 10.1186/s13613-021-00978-3.

Characteristics and outcome of COVID-19 patients admitted to the ICU: a nationwide cohort study on the comparison between the first and the consecutive upsurges of the second wave of the COVID-19 pandemic in the Netherlands

Dave A Dongelmans  1   2 , Fabian Termorshuizen  3   4 , Sylvia Brinkman  1   5 , Ferishta Bakhshi-Raiez  1   5 , M Sesmu Arbous  1   6 , Dylan W de Lange  1   7 , Bas C T van Bussel  8   9 , Nicolette F de Keizer  1   5 ; Dutch COVID-19 Research Consortium
Collaborators, Affiliations

Characteristics and outcome of COVID-19 patients admitted to the ICU: a nationwide cohort study on the comparison between the first and the consecutive upsurges of the second wave of the COVID-19 pandemic in the Netherlands

Dave A Dongelmans et al. Ann Intensive Care. .

Abstract

Background: To assess trends in the quality of care for COVID-19 patients at the ICU over the course of time in the Netherlands.

Methods: Data from the National Intensive Care Evaluation (NICE)-registry of all COVID-19 patients admitted to an ICU in the Netherlands were used. Patient characteristics and indicators of quality of care during the first two upsurges (N = 4215: October 5, 2020-January 31, 2021) and the final upsurge of the second wave, called the 'third wave' (N = 4602: February 1, 2021-June 30, 2021) were compared with those during the first wave (N = 2733, February-May 24, 2020).

Results: During the second and third wave, there were less patients treated with mechanical ventilation (58.1 and 58.2%) and vasoactive drugs (48.0 and 44.7%) compared to the first wave (79.1% and 67.2%, respectively). The occupancy rates as fraction of occupancy in 2019 (1.68 and 1.55 vs. 1.83), the numbers of ICU relocations (23.8 and 27.6 vs. 32.3%) and the mean length of stay at the ICU (HRs of ICU discharge = 1.26 and 1.42) were lower during the second and third wave. No difference in adjusted hospital mortality between the second wave and the first wave was found, whereas the mortality during the third wave was considerably lower (OR = 0.80, 95% CI [0.71-0.90]).

Conclusions: These data show favorable shifts in the treatment of COVID-19 patients at the ICU over time. The adjusted mortality decreased in the third wave. The high ICU occupancy rate early in the pandemic does probably not explain the high mortality associated with COVID-19.

Keywords: COVID-19; Coronavirus; Critical Care; Intensive Care; Mortality; Outcome.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Number of COVID-19 patients present at the general ward in hospital and at the ICU during the pandemic in the Netherlands
Fig. 2
Fig. 2
Crude and adjusted logistic regression showing Odds ratios of hospital death during Wave 2 and Wave 3, and the period in-between compared to Wave 1 (see Additional file 1: Table S2). Wave 1, February, 2020–May 24, 2020. Period in-between, May 25, 2020–October 4, 2020. Wave 2: first and second upsurge of Wave 2, October 5, 2020–January 31, 2021. Wave 3: final upsurge of Wave 2, February 1–June 30, 2021
Fig. 3
Fig. 3
Crude and adjusted Cox regression showing Hazard ratios of ICU discharge during Wave 2 and Wave 3, and the period in-between compared to Wave 1 (see Additional file 1: Table S3, death as censoring event). A Hazard ratio of ICU discharge higher than 1.00 implies a comparatively high rate of discharge and, thus, a shorter length of stay at the ICU. Wave 1, February, 2020–May 24, 2020. Period in-between, May 25, 2020–October 4, 2020. Wave 2: first and second upsurge of Wave 2, October 5, 2020–January 31, 2021. Wave 3: final upsurge of Wave 2, February 1–June 30, 2021
See this image and copyright information in PMC

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