Cargando…

Practice Changes Among Patients Without COVID-19 Receiving Mechanical Ventilation During the Early COVID-19 Pandemic

The COVID-19 pandemic led to rapid changes in care delivery for critically ill patients, due to factors including increased numbers of ICU patients, shifting staff roles, and changed care locations. As these changes may have impacted the care of patients without COVID-19, we assessed changes in comm...

Descripción completa

Detalles Bibliográficos
Autores principales: Shankar, Divya A., Bosch, Nicholas A., Walkey, Allan J., Law, Anica C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10072312/
https://www.ncbi.nlm.nih.gov/pubmed/37025306
http://dx.doi.org/10.1097/CCE.0000000000000889
_version_ 1785019355252129792
author Shankar, Divya A.
Bosch, Nicholas A.
Walkey, Allan J.
Law, Anica C.
author_facet Shankar, Divya A.
Bosch, Nicholas A.
Walkey, Allan J.
Law, Anica C.
author_sort Shankar, Divya A.
collection PubMed
description The COVID-19 pandemic led to rapid changes in care delivery for critically ill patients, due to factors including increased numbers of ICU patients, shifting staff roles, and changed care locations. As these changes may have impacted the care of patients without COVID-19, we assessed changes in common ICU practices for mechanically ventilated patients with non-COVID acute respiratory failure at the onset of and during the COVID-19 pandemic. DESIGN: Interrupted time series analysis, adjusted for seasonality and autocorrelation where present, evaluating trends in common ICU practices prior to the pandemic (March 2016 to February 2020), at the onset of the pandemic (April 2020) and intra-pandemic (April 2020 to December 2020). SETTING: Premier Healthcare Database, containing data from 25% of U.S. discharges from January 1, 2016, to December 31, 2020. PATIENTS: Patients without COVID-19 receiving mechanical ventilation for acute respiratory failure. INTERVENTIONS: We assessed monthly rates of chest radiograph (CXR), chest CT scans, lower extremity noninvasive vascular testing (LENI), bronchoscopy, arterial catheters, and central venous catheters. MEASUREMENTS AND MAIN RESULTS: We identified 742,096 mechanically ventilated patients without COVID-19 at 545 hospitals. At the onset of the pandemic, CXR (–0.5% [–0.9% to –0.2%; p = 0.001]), LENI (LENI: –2.1% [–3.3% to –0.9%; p = 0.001]), and bronchoscopy rates (–1.0% [–1.5% to –0.6%; p < 0.001]) decreased; use of chest CT increased (1.5% [0.5–2.5%; p = 0.006]). Use of arterial lines and central venous catheters did not change significantly. Intra-pandemic, LENI (0.5% [0.3–0.7%; p < 0.001]/mo) and bronchoscopy (0.1% [0.05–0.2%; p < 0.001]/mo) trends increased relative to pre-pandemic trends, while the remainder of practices did not change significantly. CONCLUSIONS: We observed several statistically significant changes to practice patterns among patients without COVID-19 early during the pandemic. However, most of the changes were small or temporary, suggesting that routine practices in the care of mechanically ventilated patients in the ICU was not drastically affected by the pandemic.
format Online
Article
Text
id pubmed-10072312
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Lippincott Williams & Wilkins
record_format MEDLINE/PubMed
spelling pubmed-100723122023-04-05 Practice Changes Among Patients Without COVID-19 Receiving Mechanical Ventilation During the Early COVID-19 Pandemic Shankar, Divya A. Bosch, Nicholas A. Walkey, Allan J. Law, Anica C. Crit Care Explor Brief Report The COVID-19 pandemic led to rapid changes in care delivery for critically ill patients, due to factors including increased numbers of ICU patients, shifting staff roles, and changed care locations. As these changes may have impacted the care of patients without COVID-19, we assessed changes in common ICU practices for mechanically ventilated patients with non-COVID acute respiratory failure at the onset of and during the COVID-19 pandemic. DESIGN: Interrupted time series analysis, adjusted for seasonality and autocorrelation where present, evaluating trends in common ICU practices prior to the pandemic (March 2016 to February 2020), at the onset of the pandemic (April 2020) and intra-pandemic (April 2020 to December 2020). SETTING: Premier Healthcare Database, containing data from 25% of U.S. discharges from January 1, 2016, to December 31, 2020. PATIENTS: Patients without COVID-19 receiving mechanical ventilation for acute respiratory failure. INTERVENTIONS: We assessed monthly rates of chest radiograph (CXR), chest CT scans, lower extremity noninvasive vascular testing (LENI), bronchoscopy, arterial catheters, and central venous catheters. MEASUREMENTS AND MAIN RESULTS: We identified 742,096 mechanically ventilated patients without COVID-19 at 545 hospitals. At the onset of the pandemic, CXR (–0.5% [–0.9% to –0.2%; p = 0.001]), LENI (LENI: –2.1% [–3.3% to –0.9%; p = 0.001]), and bronchoscopy rates (–1.0% [–1.5% to –0.6%; p < 0.001]) decreased; use of chest CT increased (1.5% [0.5–2.5%; p = 0.006]). Use of arterial lines and central venous catheters did not change significantly. Intra-pandemic, LENI (0.5% [0.3–0.7%; p < 0.001]/mo) and bronchoscopy (0.1% [0.05–0.2%; p < 0.001]/mo) trends increased relative to pre-pandemic trends, while the remainder of practices did not change significantly. CONCLUSIONS: We observed several statistically significant changes to practice patterns among patients without COVID-19 early during the pandemic. However, most of the changes were small or temporary, suggesting that routine practices in the care of mechanically ventilated patients in the ICU was not drastically affected by the pandemic. Lippincott Williams & Wilkins 2023-04-03 /pmc/articles/PMC10072312/ /pubmed/37025306 http://dx.doi.org/10.1097/CCE.0000000000000889 Text en Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Brief Report
Shankar, Divya A.
Bosch, Nicholas A.
Walkey, Allan J.
Law, Anica C.
Practice Changes Among Patients Without COVID-19 Receiving Mechanical Ventilation During the Early COVID-19 Pandemic
title Practice Changes Among Patients Without COVID-19 Receiving Mechanical Ventilation During the Early COVID-19 Pandemic
title_full Practice Changes Among Patients Without COVID-19 Receiving Mechanical Ventilation During the Early COVID-19 Pandemic
title_fullStr Practice Changes Among Patients Without COVID-19 Receiving Mechanical Ventilation During the Early COVID-19 Pandemic
title_full_unstemmed Practice Changes Among Patients Without COVID-19 Receiving Mechanical Ventilation During the Early COVID-19 Pandemic
title_short Practice Changes Among Patients Without COVID-19 Receiving Mechanical Ventilation During the Early COVID-19 Pandemic
title_sort practice changes among patients without covid-19 receiving mechanical ventilation during the early covid-19 pandemic
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10072312/
https://www.ncbi.nlm.nih.gov/pubmed/37025306
http://dx.doi.org/10.1097/CCE.0000000000000889
work_keys_str_mv AT shankardivyaa practicechangesamongpatientswithoutcovid19receivingmechanicalventilationduringtheearlycovid19pandemic
AT boschnicholasa practicechangesamongpatientswithoutcovid19receivingmechanicalventilationduringtheearlycovid19pandemic
AT walkeyallanj practicechangesamongpatientswithoutcovid19receivingmechanicalventilationduringtheearlycovid19pandemic
AT lawanicac practicechangesamongpatientswithoutcovid19receivingmechanicalventilationduringtheearlycovid19pandemic