Equal critical care consideration for both immunocompromised and immunocompetent patients during the COVID-19 surge [post]

Cynthia DENIS, Mathieu BALDACINI, Maleka SCHENCK, Thierry ARTZNER, Yoann GRIMAUD, Thierry LAVIGNE, Ferhat MEZIANI, Vincent CASTELAIN, Raphael CLERE-JEHL, Francis SCHNEIDER, Guillaume MOREL
2020 unpublished
Background: SARS-CoV-2 disease (COVID) affects all sections of the community, but some people contract the disease in a form requiring ICU admission. Immunocompromised patients (ICP) figure among the fragile patients whose access to critical care may be denied in the event of ICU bed-shortage. Our aims were: 1) to describe our management experience in seeking to assure equal critical-care consideration for both ICP and immuno-competent patients during the COVID surge, 2) to assess how
more » ... this would be in terms of outcome for all patients, 3) to compare ICU stays of ICP, whether they survived or not, so as to detect possible prognostic factors.Methods: We conducted a cohort study in medical ICUs of a university-affiliated hospital hit by an uncontrolled cluster of COVID. We compared the levels of activity before and during COVID: number of patients (whether COVID+ or COVID-, whether ICP or not); bed-occupancy and bed-availability; mortality rates and the need for sanitary evacuations analyzed to avoid triage decisions.Results: During the pre-COVID period, 396 patients, including 9.3% ICP, were admitted. During the COVID period, 547 patients, including 243 COVID+ (of whom 24 ICP), were admitted: this required an 8 ICU bed-extension (+14.5% beds), a transfer of 69 immuno-competent COVID- patients to surgical ICU step-down beds, and the transfer of 22 immuno-competent COVID patients to distant hospitals. Despite sanitary evacuations, there was a daily average of 2 ICU-access refusals, the patients being taken in charge by step-down units. Health evacuations were decided on when the weekly number of COVID admissions doubled. No ICP was denied access to the ICU; no COVID- ICP was hospitalized during the first 9 weeks of the surge. 28-day mortality was 41.6% in ICP versus 27.3% in immuno-competent patients (p=0.021, log-rank test). With the exception of SAPSII and SOFA, no factor was different between clinical and ICU-stay characteristics among ICP, whether surviving or not.Conclusion and Relevance: Equal critical-care consideration for both immuno-compromised and immunocompetent patients during the COVID-19 surge was possible with acceptable outcome. Sanitary doctrine and fine-tuned hospital logistics were mandatory both at local and national level to reach this goal.
doi:10.21203/rs.3.rs-57911/v1 fatcat:nmllmwtq2nd5tl4p7anl76vhli