Pedro Dammert, MD
Bayhealth Hospital Kent Campus
Dover, Delaware
Disclosure information not submitted.
Sandeep Chennadi, MD
Intensivist
Bayhealth Medical Center, United States
Disclosure information not submitted.
Avinash Ramdass, MD
Intensivist
Bayhealth Medical Center, United States
Disclosure information not submitted.
Megan Stallings, PA-C
Intensive Care APP
Bayhealth Medical Center, United States
Disclosure information not submitted.
Laura Tolson, ACNP, AG-ACNP
Intensive Care APP
Bayhealth Medical Center, United States
Disclosure information not submitted.
Meghan Holland, NP-C
Intensive Care APP
Bayhealth Medical Center, United States
Disclosure information not submitted.
Nanda Din, MD
Intensivist
Bayhealth Medical Center, United States
Disclosure information not submitted.
Vinoo Ramsaran, MD
Intensivist
Bayhealth Medical Center, United States
Disclosure information not submitted.
Title: Outcomes of COVID-19 Patients in a Community Hospital with a High Flow Oxygen Use Strategy
Introduction: COVID-19 is an ongoing global pandemic that causes respiratory failure and ARDS. Its management, including respiratory support, was unclear in the beginning of the pandemic. Some medical centers performed early endotracheal intubation due to concerns of aerosolization with high flow oxygen and concern for patient self-induced lung injury. We decided to use high flow oxygen and not to use an early intubation strategy. The purpose of this study is to describe the outcomes of patients with COVID-19 managed with this strategy.
Methods: Retrospective review of all consecutive patients admitted with COVID-19 to Bayhealth Medical Center- Kent Campus since March 14th 2020 (first patient) until April 13th 2020. The data was analyzed using descriptive statistics.
Results: 112 patients were admitted with COVID-19. The median age was 57 years old, 56.2% were male, 51.7% were obese, 55.3% had hypertension, 37.5% had diabetes, 9.8% had CKD and 49.1% had hypoxemia during admission. 16.9% of patients required high flow oxygen and 14.2% required mechanical ventilation as the highest level of respiratory support required. Mortality rates were 12.5%, 15.7%, 62.5% and 37.1% for all patients, patients that required high flow oxygen as the highest level of respiratory support, patients that required mechanical ventilation as the highest level of respiratory support, and patients that required high flow oxygen or mechanical ventilation; respectively. Of all patients that required high flow oxygen at any point during hospital admission (25), 76% (19) did not require mechanical ventilation, 44% did awake prone, 52% received steroids and 8% received tocilizumab before mechanical ventilation. The patients that ended up requiring mechanical ventilation were older and had higher rates of obesity and comorbidities.
Conclusions: A strategy of use of high flow oxygen, steroids and tocilizumab in a community hospital led to outcomes in overall mortality comparable with US hospital mortality (15.61%, Asch, JAMA 2020), and mortality for patients requiring respiratory support with high flow oxygen or mechanical ventilation comparable to centers that did early intubation (33.3%, Krishnan, ATS 2021). This approach allowed for optimal utilization of resources and avoided intubation in 76% of patients requiring high flow oxygen.