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. 2022 Oct-Dec;34(4):433-442.
doi: 10.5935/0103-507X.20210037-pt. Epub 2023 Mar 3.

What changed between the peak and plateau periods of the first COVID-19 pandemic wave? A multicentric Portuguese cohort study in intensive care

[Article in English, Portuguese]
Rui Antunes Pereira  1 , Marta Sousa  2 , José Pedro Cidade  3 , Luís Melo  4 , Diogo Lopes  1 , Sara Ventura  5 , Irene Aragão  6 , Raul Miguel de Freitas Lima Neto  7 , Elena Molinos  8 , Ana Marques  9 , Nelson Cardoso  10 , Flávio Marino  11 , Filipa Brás Monteiro  12 , Ana Pinho Oliveira  13 , Rogério C Silva  14 , André Miguel Neto Real  15 , Bruno Sarmento Banheiro  16 , Renato Reis  2 , Maria Adão-Serrano  2 , Ana Cracium  2 , Ana Valadas  2 , João Miguel Ribeiro  2 , Pedro Póvoa  3 , Camila Tapadinhas  3 , Vítor Mendes  3 , Luís Coelho  3 , Raquel Maia  4 , Paulo Telles Freitas  4 , Isabel Amorim Ferreira  4 , Tiago Ramires  4 , Luís Silva Val-Flores  1 , Mariana Cascão  1 , Rita Alves  1 , Simão C Rodeia  5 , Cleide Barrigoto  5 , Rosa Cardiga  5 , Maria João Ferreira da Silva  6 , Bruno Vale  6 , Tatiana Fonseca  7 , Ana Lúcia Rios  7 , João Camões  8 , Danay Pérez  8 , Susana Cabral  9 , Maria Inês Ribeiro  10 , João João Mendes  4   17 , João Gouveia  2   17 , Susana Mendes Fernandes  2
Affiliations

What changed between the peak and plateau periods of the first COVID-19 pandemic wave? A multicentric Portuguese cohort study in intensive care

[Article in English, Portuguese]
Rui Antunes Pereira et al. Rev Bras Ter Intensiva. 2022 Oct-Dec.

Abstract
in English, Portuguese

Objective: To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal.

Methods: This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined.

Results: Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39; p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136; p = 0.6), antibiotic therapy (57% versus 64%; p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%; p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5]; p = 0.002) and presented a higher use of vasopressors (47% versus 36%; p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%; p < 0.001) at admission, prone positioning (45% versus 36%; p = 0.04), and hydroxychloroquine (59% versus 10%; p < 0.001) and lopinavir/ritonavir (41% versus 10%; p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%; p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau.

Conclusion: There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave.

Objetivo: Analisar e comparar as características de pacientes críticos com a COVID-19, a abordagem clínica e os resultados entre os períodos de pico e de platô na primeira onda pandêmica em Portugal.

Métodos: Este foi um estudo de coorte multicêntrico ambispectivo, que incluiu pacientes consecutivos com a forma grave da COVID-19 entre março e agosto de 2020 de 16 unidades de terapia intensiva portuguesas. Definiram-se as semanas 10 - 16 e 17 - 34 como os períodos de pico e platô.

Resultados: Incluíram-se 541 pacientes adultos com mediana de idade de 65 [57 - 74] anos, a maioria do sexo masculino (71,2%). Não houve diferenças significativas na mediana de idade (p = 0,3), no Simplified Acute Physiology Score II (40 versus 39; p = 0,8), na pressão parcial de oxigênio/fração inspirada de oxigênio (139 versus 136; p = 0,6), na terapia com antibióticos na admissão (57% versus 64%; p = 0,2) ou na mortalidade aos 28 dias (24,4% versus 22,8%; p = 0,7) entre o período de pico e platô. Durante o período de pico, os pacientes tiveram menos comorbidades (1 [0 - 3] versus 2 [0 - 5]; p = 0,002); fizeram mais uso de vasopressores (47% versus 36%; p < 0,001) e ventilação mecânica invasiva na admissão (58,1% versus 49,2%; p < 0,001), e tiveram mais prescrição de hidroxicloroquina (59% versus 10%; p < 0,001), lopinavir/ritonavir (41% versus 10%; p < 0,001) e posição prona (45% versus 36%; p = 0,04). Entretanto, durante o platô, observou-se maior uso de cânulas nasais de alto fluxo (5% versus 16%; p < 0,001) na admissão, remdesivir (0,3% versus 15%; p < 0,001) e corticosteroides (29% versus 52%; p < 0,001), além de menor tempo de internação na unidade de terapia intensiva (12 versus 8 dias; p < 0,001).

Conclusão: Houve mudanças significativas nas comorbidades dos pacientes, nos tratamentos da unidade de terapia intensiva e no tempo de internação entre os períodos de pico e platô na primeira onda da COVID-19.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Intensive care unit admissions and median age of COVID-19 patients.
Figure 2
Figure 2
Age group, comorbidities and associated intensive care unit mortality rates in critically ill COVID-19 patients.
See this image and copyright information in PMC

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