Outcomes of patients with COVID-19 Acute Respiratory Distress Syndrome requiring Invasive Mechanical Ventilation admitted to an Intensive Care Unit in South Africa

dc.contributor.advisorPiercy, Jenna
dc.contributor.advisorVan Zyl-Smit, Richard
dc.contributor.authorArnold-Day, Christel
dc.date.accessioned2023-03-13T14:19:05Z
dc.date.available2023-03-13T14:19:05Z
dc.date.issued2022
dc.date.updated2023-02-20T12:13:07Z
dc.description.abstractBackground Up to 30% of patients with COVID-19 pneumonia may require ICU admission or mechanical ventilation [Guan et al., 2020; Huang et al., 2020]. Data from low- and middle-income countries for COVID-19 ARDS are limited. Groote Schuur Hospital in Cape Town, South Africa expanded its ICU service to support patients with COVID-19 ARDS requiring invasive mechanical ventilation (IMV). We report on patients' characteristics and outcomes from two pandemic waves. Methods All patients with COVID-19 ARDS admitted to the ICU for IMV were included in this prospective cohort study. Data were collected from 5th April 2020 to 5th April 2021. Ethical approval was granted (HREC: 362/2020), consent was waived for deceased patients and deferred for survivors. Results Over the 12-month study period 461 patients were admitted to the designated COVID-19 ICU. Of these, 380 patients met study criteria and 377 had confirmed hospital discharge outcomes. The median age of patients was 51 years (range 17-71), 50.5% were female and the median BMI was 32kg/m2 (IQR 28-38). The median P/F ratio was 97 (IQR 71.5-127.5) after IMV was initiated. Comorbidities included diabetes (47.6%), hypertension (46.3%) and HIV infection (10%). Of the patients admitted, 30.8% survived to hospital discharge with a median ICU length of stay of 19.5 days (IQR 9- 36). Predictors of mortality after adjusting for confounders were: male (OR:1.79), increasing age (OR:1.04) and SOFA score (OR:1.29). Conclusion In a resource limited environment, escalation of ICU IMV support achieved a 30.8% hospital survival in patients with COVID-19 ARDS. The ability to predict survival remains difficult given this complex disease.
dc.identifier.apacitationArnold-Day, C. (2022). <i>Outcomes of patients with COVID-19 Acute Respiratory Distress Syndrome requiring Invasive Mechanical Ventilation admitted to an Intensive Care Unit in South Africa</i>. (). ,Faculty of Health Sciences ,Department of Anaesthesia and Perioperative Medicine. Retrieved from http://hdl.handle.net/11427/37426en_ZA
dc.identifier.chicagocitationArnold-Day, Christel. <i>"Outcomes of patients with COVID-19 Acute Respiratory Distress Syndrome requiring Invasive Mechanical Ventilation admitted to an Intensive Care Unit in South Africa."</i> ., ,Faculty of Health Sciences ,Department of Anaesthesia and Perioperative Medicine, 2022. http://hdl.handle.net/11427/37426en_ZA
dc.identifier.citationArnold-Day, C. 2022. Outcomes of patients with COVID-19 Acute Respiratory Distress Syndrome requiring Invasive Mechanical Ventilation admitted to an Intensive Care Unit in South Africa. . ,Faculty of Health Sciences ,Department of Anaesthesia and Perioperative Medicine. http://hdl.handle.net/11427/37426en_ZA
dc.identifier.ris TY - Master Thesis AU - Arnold-Day, Christel AB - Background Up to 30% of patients with COVID-19 pneumonia may require ICU admission or mechanical ventilation [Guan et al., 2020; Huang et al., 2020]. Data from low- and middle-income countries for COVID-19 ARDS are limited. Groote Schuur Hospital in Cape Town, South Africa expanded its ICU service to support patients with COVID-19 ARDS requiring invasive mechanical ventilation (IMV). We report on patients' characteristics and outcomes from two pandemic waves. Methods All patients with COVID-19 ARDS admitted to the ICU for IMV were included in this prospective cohort study. Data were collected from 5th April 2020 to 5th April 2021. Ethical approval was granted (HREC: 362/2020), consent was waived for deceased patients and deferred for survivors. Results Over the 12-month study period 461 patients were admitted to the designated COVID-19 ICU. Of these, 380 patients met study criteria and 377 had confirmed hospital discharge outcomes. The median age of patients was 51 years (range 17-71), 50.5% were female and the median BMI was 32kg/m2 (IQR 28-38). The median P/F ratio was 97 (IQR 71.5-127.5) after IMV was initiated. Comorbidities included diabetes (47.6%), hypertension (46.3%) and HIV infection (10%). Of the patients admitted, 30.8% survived to hospital discharge with a median ICU length of stay of 19.5 days (IQR 9- 36). Predictors of mortality after adjusting for confounders were: male (OR:1.79), increasing age (OR:1.04) and SOFA score (OR:1.29). Conclusion In a resource limited environment, escalation of ICU IMV support achieved a 30.8% hospital survival in patients with COVID-19 ARDS. The ability to predict survival remains difficult given this complex disease. DA - 2022_ DB - OpenUCT DP - University of Cape Town KW - Acute respiratory distress syndrome KW - COVID-19, SARS-COV-2 KW - critically ill KW - invasive mechanical ventilation KW - South Africa KW - Africa KW - hospital mortality outcomes KW - low- and middle-income countries LK - https://open.uct.ac.za PY - 2022 T1 - Outcomes of patients with COVID-19 Acute Respiratory Distress Syndrome requiring Invasive Mechanical Ventilation admitted to an Intensive Care Unit in South Africa TI - Outcomes of patients with COVID-19 Acute Respiratory Distress Syndrome requiring Invasive Mechanical Ventilation admitted to an Intensive Care Unit in South Africa UR - http://hdl.handle.net/11427/37426 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/37426
dc.identifier.vancouvercitationArnold-Day C. Outcomes of patients with COVID-19 Acute Respiratory Distress Syndrome requiring Invasive Mechanical Ventilation admitted to an Intensive Care Unit in South Africa. []. ,Faculty of Health Sciences ,Department of Anaesthesia and Perioperative Medicine, 2022 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/37426en_ZA
dc.language.rfc3066eng
dc.publisher.departmentDepartment of Anaesthesia and Perioperative Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.subjectAcute respiratory distress syndrome
dc.subjectCOVID-19, SARS-COV-2
dc.subjectcritically ill
dc.subjectinvasive mechanical ventilation
dc.subjectSouth Africa
dc.subjectAfrica
dc.subjecthospital mortality outcomes
dc.subjectlow- and middle-income countries
dc.titleOutcomes of patients with COVID-19 Acute Respiratory Distress Syndrome requiring Invasive Mechanical Ventilation admitted to an Intensive Care Unit in South Africa
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMPhil
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