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Intensive care burden of COVID-19 in tertiary care hospitals during the first year of outbreak in Kawasaki City,Japan: A retrospective cohort study
Institution:1. Department of Infectious Disease, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan;2. Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan;3. Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan;4. Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;5. Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan;6. Department of Emergency Medicine, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan
Abstract:IntroductionThis study aimed to describe the changes in the intensive care burden of coronavirus disease 2019 (COVID-19) during the first year of outbreak in Japan.MethodsThis retrospective cohort study included COVID-19 patients who received mechanical ventilation (MV) support in two designated hospitals for critical patients in Kawasaki City. We compared the lengths of MV and stay in the intensive care unit (ICU) or high care unit (HCU) according to the three epidemic waves. We calculated in-hospital mortality rates in patients with or without MV.ResultsThe median age of the sample was 65.0 years, and 22.7% were women. There were 37, 29, and 62 patients in the first (W1), second (W2), and third waves (W3), respectively. Systemic steroids, remdesivir, and prone positioning were more frequent in W2 and W3. The median length of MV decreased from 18.0 days in W1 to 13.0 days in W3 (P = 0.019), and that of ICU/HCU stay decreased from 22.0 days in W1 to 15.5 days in W3 (P = 0.027). The peak daily number of patients receiving MV support was higher at 18 patients in W1, compared to 8 and 15 patients in W2 and W3, respectively. The mortality rate was 23.4%, which did not significantly change (P = 0.467).ConclusionsThe lengths of MV and ICU/HCU stay per patient decreased over time. Despite an increase in the number of COVID-19 patients who received MV in W3, this study may indicate that the intensive care burden during the study period did not substantially increase.
Keywords:COVID-19  Intensive care  Mechanical ventilation  SARS-CoV-2  Tertiary care  COVID-19"}  {"#name":"keyword"  "$":{"id":"kwrd0040"}  "$$":[{"#name":"text"  "_":"coronavirus disease 2019  ECMO"}  {"#name":"keyword"  "$":{"id":"kwrd0050"}  "$$":[{"#name":"text"  "_":"extracorporeal membrane oxygenation  HCU"}  {"#name":"keyword"  "$":{"id":"kwrd0060"}  "$$":[{"#name":"text"  "_":"high care unit  ICU"}  {"#name":"keyword"  "$":{"id":"kwrd0070"}  "$$":[{"#name":"text"  "_":"intensive care unit  SARS-CoV-2"}  {"#name":"keyword"  "$":{"id":"kwrd0080"}  "$$":[{"#name":"text"  "_":"severe acute respiratory syndrome coronavirus 2
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