Hospital Variation in Management and Outcomes of Acute Respiratory Distress Syndrome Due to COVID-19
Abstrak
OBJECTIVES:. To describe hospital variation in use of “guideline-based care” for acute respiratory distress syndrome (ARDS) due to COVID-19. DESIGN:. Retrospective, observational study. SETTING:. The Society of Critical Care Medicine’s Discovery Viral Infection and RESPIRATORY ILLNESS UNIVERSAL STUDY COVID-19 REGISTRY. PATIENTS:. Adult patients with ARDS due to COVID-19 between February 15, 2020, and April 12, 2021. INTERVENTIONS:. Hospital-level use of “guideline-based care” for ARDS including low-tidal-volume ventilation, plateau pressure less than 30 cm H2O, and prone ventilation for a Pao2/Fio2 ratio less than 100. MEASUREMENTS AND MAIN RESULTS:. Among 1,495 adults with COVID-19 ARDS receiving care across 42 hospitals, 50.4% ever received care consistent with ARDS clinical practice guidelines. After adjusting for patient demographics and severity of illness, hospital characteristics, and pandemic timing, hospital of admission contributed to 14% of the risk-adjusted variation in “guideline-based care.” A patient treated at a randomly selected hospital with higher use of guideline-based care had a median odds ratio of 2.0 (95% CI, 1.1–3.4) for receipt of “guideline-based care” compared with a patient receiving treatment at a randomly selected hospital with low use of recommended therapies. Median-adjusted inhospital mortality was 53% (interquartile range, 47–62%), with a nonsignificantly decreased risk of mortality for patients admitted to hospitals in the highest use “guideline-based care” quartile (49%) compared with the lowest use quartile (60%) (odds ratio, 0.7; 95% CI, 0.3–1.9; p = 0.49). CONCLUSIONS:. During the first year of the COVID-19 pandemic, only half of patients received “guideline-based care” for ARDS management, with wide practice variation across hospitals. Strategies that improve adherence to recommended ARDS management strategies are needed.
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Shelsey W. Johnson, MD
Michael A. Garcia, MD
Emily K. Q. Sisson, MA
Christopher R. Sheldrick, PhD
Vishakha K. Kumar, MD, MBA
Karen Boman, BA
Scott Bolesta, PharmD
Vikas Bansal, MBBS, MPH
Amos Lal, MBBS
J. P. Domecq, MD, MS
Roman R. Melamed, MD
Amy B. Christie, MD
Abdurrahman Husain, MD
Santiago Yus, MBBS
Ognjen Gajic, MD, MSc
Rahul Kashyap, MBBS, MBA
Allan J. Walkey, MD, MSc
from the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group
Oscar Y. Gavidia
Felipe Pachon
Yeimy A. Sanchez
Mohamed El Kassas
Mohamed Badr
Ahmed Tawheed
Ahmed Tawheed
Hend Yahia
Wataru Matsuda
Reina Suzuki
Reina Suzuki
Masamitsu Sanui
Sho Horikita
Yuki Itagaki
Akira Kodate
Reina Suzuki
Akira Kodate
Yuki Takahashi
Koyo Moriki
Muhammad Sohaib
Asghar, Mashaal Syed
Syed Anosh
Ali Naqvi
Borisovich Zabolotskikh
Konstantin Dmitrievich Zybin
Sergey Vasilevich Sinkov
Tatiana Sergeevna Musaeva
Mohammed A. Almazyad
Mohammed I. Alarifi
Jara M. Macarambon
Ahmad Abdullah Bukhari
Hussain A. Albahrani
Kazi N. Asfina
Kaltham M. Aldossary
Marija Zdravkovic
Zoran Todorovic
Viseslav Popadic
Slobodan Klasnja
Predrag D. Stevanovic
Dejan S. Stojakov
Duska K. Ignjatovic
Suzana C. Bojic
Marina M. Bobos
Irina B. Nenadic
Milica S. Zaric
Marko D. Djuric
Vladimir R. Djukic
Santiago Yus
Belen C. Martin
Uluhan Sili
Huseyin Bilgin
Pinar Ay
Roman R. Melamed
David M. Tierney
Love A. Patel
Vino S. Raj
Barite U. Dawud
Narayana Mazumder
Abbey Sidebottom
Alena M. Guenther
Benjamin D. Krehbiel
Nova J. Schmitz
Stacy L. Jepsen
Lynn Sipsey
Anna Schulte
Whitney Wunderlich
Cecely Hoyt
Kenneth W. Dodd
Nicholas Goodmanson
Kathleen Hesse
Paige Bird
Chauncey Weinert
Nathan Schoenrade
Abdulrahman Altaher
Esmael Mayar
Matthew Aronson
Tyler Cooper
Monica Logan
Brianna Miner
Gisele Papo
Abdulrahman Al-Fares
Anmol Kharbanda
Sunil Jhajhria
Zachary Fyffe
Amy B. Christie
Dennis W. Ashley
Rajani Adiga
Andrea Sikora Newsome
Christy C. Forehand
Rebecca Bruning
Timothy W. Jones
Moldovan Sabov
Fatema Zaidi
Fiona Tissavirasingham
Dhatri Malipeddi
Valerie M. Banner-Goodspeed
Somnath Bose
Lauren E. Kelly
Melisa Joseph
Marie McGourty
Krystal Capers
Benjamin Hoenig
Maria C. Karamourtopoulos
Anica C. Law
Elias N. Baedorf Kassis
Allan J. Walkey
Sushrut S. Waikar
Michael A. Garcia
Mia Colona
Zoe Kibbelaar
Michael Leong
Daniel Wallman
Kanupriya Soni
Jennifer Maccarone
Joshua Gilman
Ycar Devis
Joseph Chung
Munizay Paracha
David N. Lumelsky
Madeline DiLorenzo
Najla Abdurrahman
Shelsey Johnson
Kimberly Zammit
Patrick J. McGrath
William Loeffler
Maya R. Chilbert
Jean-Baptiste Mesland
Pierre Henin
Hélène Petre
Isabelle Buelens
Anne-Catherine Gerard
Rayan E. Ihle
Shelda A. Martin
Elaine A. Davis
Salim Surani
Joshua White
Aftab Khan
Rahul Dhahwal
Sreekanth Cheruku
Farzin Ahmed
Christopher Deonarine
Ashley Jones
Mohammad-Ali Shaikh
David Preston
Jeanette Chin
Steven K. Daugherty
Sam Atkinson
Kelly Shrimpton
Raquel R. Bartz
Vijay Krishnamoorthy
Bryan Kraft
Aaron Pulsipher
Eugene Friedman
Sachin Mehta
David P. Yamane
Ivy Benjenk
Nivedita Prasanna
Katharine Nault
Ronald A. Reilkoff
Julia A. Heneghan
Sarah Eichen
Lexie Goertzen
Scott Rajala
Ghislaine Feussom
Ben Tang
Mayo Clinic Arizona
Rodrigo Cartin-Ceba
Ayan Sen
Amanda Palacios
Giyth M. Mahdi
Rahul Kashyap
Ognjen Gajic
Vikas Bansal
Aysun Tekin
Amos Lal
John C. O’Horo
Neha N. Deo
Mayank Sharma
Shahraz Qamar
Juan Pablo Domecq
Romil Singh
Alex Niven
Mayo Clinic
Eau Claire
Abigail T. La Nou
Marija Bogojevic
Barbara Mullen
Devang Sanghavi
Pramod Guru
Pablo Moreno Franco
Karthik Gnanapandithan
Hollie Saunders
Zachary Fleissner
Juan Garcia
Alejandra Yu Lee Mateus
Siva Naga Yarrarapu
Nirmaljot Kaur
Abhisekh Giri
Syed Anjum Khan
Nitesh Kumar Jain
Thoyaja Koritala
Chakradhar Venkata
Miriam Engemann
Annamarie Mantese
Yasir Tarabichi
Adam Perzynski
Christine Wang
Dhatri Kotekal
Bhagat S. Aulakh
Sandeep Tripathi
Jennifer A. Bandy
Lisa M. Kreps
Dawn R. Bollinger
Jennifer A. Bandy
Roger Scott Stienecker
Andre G. Melendez
Tressa A. Brunner
Sue M. Budzon
Jessica L. Heffernan
Janelle M. Souder
Tracy L. Miller
Andrea G. Maisonneuve
Antonia L. Vilella
Sara B. Kutner
Kacie Clark
Danielle Moore
Harry L. Anderson, III
Dixy Rajkumar
Ali Abunayla
Jerrilyn Heiter
Howard A. Zaren
Stephanie J. Smith
Grant C. Lewis
Lauren Seames
Cheryl Farlow
Judy Miller
Gloria Broadstreet
Anthony Martinez
Micheal Allison
Aniket Mittal
Rafael Ruiz
Aleta Skaanland
Robert Ross
Neha Gupta
Tracy L. Jones
Shonda C. Ayers
Amy B. Harrell
Dr. Brent R. Brown
Abdurrahman Husain
Atul Malhotra
Qais Zawaydeh
Dragana Markotić
Ivana Bošnjak
Emily A. Vail
Susannah Nicholson
Rachelle B. Jonas
AnnaRose E. Dement
William Tang
Mark DeRosa
Robert E. Villarreal
Patrick W. McGonagill
Colette Galet
Janice Hubbard
David Wang
Lauren Allan
Aditya Badheka
Madhuradhar Chegondi
Roger A. Alvarez
Amarilys Alarcon-Calderon
Marie Anne Sosa
Sunita K. Mahabir
Mausam J. Patel
Faraaz Ali Shah
Byron Chuan
Sagar L. Rawal
Manal Piracha
Joseph E. Tonna
Nicholas M. Levin
Kayte Suslavich
Rachel Tsolinas
Zachary T. Fica
Chloe R. Skidmore
Renee D. Stapleton
Anne E. Dixon
Olivia Johnson
Sara S. Ardren
Stephanie Burns
Anna Raymond
Erika Gonyaw
Kevin Hodgdon
Chloe Housenger
Benjamin Lin
Karen McQuesten
Heidi Pecott-Grimm
Julie Sweet
Sebastian Ventrone
Murtaza Akhter
Rania Abdul Rahman
Mary Mulrow
Ashish K. Khanna
Lynne Harris
Bruce Cusson
Jacob Fowler
David Vaneenenaam
Glen McKinney
Imoh Udoh
Kathleen Johnson
Vishwanath Pattan
Jessica Papke
Ismail Jimada
Nida Mhid
Samuel Chakola
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- 2022
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- DOI
- 10.1097/CCE.0000000000000638
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