Anita Shallal, MD
Fellow, Infectious Disease
Henry Ford Hospital, United States
Disclosure information not submitted.
Erica Herc, MD
Program Director, Infectious Disease
Henry Ford Hospital, United States
Disclosure information not submitted.
Labib Debiane, MD
Director of Pleural Disease
Henry Ford Hospital, United States
Disclosure information not submitted.
Title: Initial Approach to Treatment of COVID-19 Infected Patients in the ICU at Academic Centers in the US
Introduction: The overwhelming influx of critically ill patients with coronavirus disease 2019 (COVID-19), a novel, highly infectious respiratory pathogen, created unprecedented circumstances for intensive care unit (ICU) providers early in the pandemic. Providers were strained to make management decisions with minimal supportive evidence and many uncertainties about the disease. This study aimed to determine the initial strategies adopted by academic institutions in the US for treating COVID-19 infected patients in the ICU.
Methods: This study was a cross-sectional, electronic survey of 191 fellowship program directors in medical critical care in the United States early in the pandemic (April 16 to May 4, 2020).
Results: The response rate was 22%. Most programs (81%) had a standardized protocol for management. Thirteen different medications were reported to be in use for the treatment of COVID-19 – the most common was tocilizumab (54.8%), followed by hydroxychloroquine (52.4%) azithromycin (40.5%). Most programs were using pharmacologic therapies outside the context of a clinical trial (57.1%). For hypoxemic respiratory failure, 54.8% of programs used non-invasive positive pressure ventilation (NIPPV), whereas 45.2% did not use NIPPV at all. For intubated patients, most used a high PEEP/low FiO2 strategy (83.3%) and prone positioning (90.5%). Extracorporeal membrane oxygenation was used at 84.1% of programs who had the capability to offer it.
Conclusions: Our study describes the initial strategies adopted by academic institutions in the US for treating COVID-19 infected patients in the ICU. Academic centers rapidly created and integrated treatment protocols for these patients early in the pandemic. However, treatment strategies (both pharmacologic and non-pharmacologic) were varied, reflecting inconsistent interpretation of the limited evidence available at the time. In most cases, medications were used outside the context of a clinical trial, conflicting with societal recommendations. Corticosteroids, which have now been shown to have the most consistent and significant benefit for treating critically ill patients with COVID-19, were initially used in a minority of programs (26.2%). Further studies are implicated to shed light on optimizing our healthcare system's response and readiness for future pandemics.