Clinical course and outcomes of critically-ill patients with COVID-19 infection: A systematic review

Serafim, Rodrigo B.; Póvoa, Pedro; Souza-Dantas, Vicente; Kalil, André C.; Salluh, Jorge I.F.

BACKGROUND: COVID-19 is a major cause of hospital admission and represents a challenge for patient management during intensive care unit (ICU) stay. OBJECTIVES: We aimed to describe the clinical course and outcomes of COVID-19 pneumonia in critically ill patients. DATA SOURCE: We performed a systematic search of peer-reviewed publications in MEDLINE, EMBASE and Cochrane Library up to August 15(th), 2020. Preprints and reports were also included if they met the inclusion criteria. STUDY ELIGIBILITY CRITERIA: Full-text prospective, retrospective or registry-based publications describing outcomes in patients admitted to the ICU for COVID-19, using a validated test. PARTICIPANTS: Critically ill patients admitted in the ICU with COVID-19 infection. RESULTS: From 32 articles included, a total of 69,093 patients were admitted to the ICU and were evaluated. Most patients admitted to the ICU were male (76,165/128,168 (59%); 26 studies) and the mean patient age was 56 (95% CI 48.5 – 59.8) years-old. Studies described high ICU mortality (21,145/65,383; 32.3%; 15 studies). The median length of ICU stay was 9.0 (95% CI 6.5 – 11.2) days, described in 5 studies. More than half of patients admitted to the ICU required mechanical ventilation (31,213/53,465; 58%; 23 studies) and among them mortality was very high (27,972/47,632, 59%, 6 studies). The duration of mechanical ventilation was 8.4 (95% CI 1.6 – 13.7) days. The main interventions described were the use of non-invasive ventilation, extracorporeal membrane oxygenation, renal replacement therapy and vasopressors. CONCLUSION: This systematic review including approximately 69,000 ICU patients demonstrates that COVID-19 infection in critically ill patients is associated with high need for life-sustaining interventions, high mortality and prolonged length of ICU stay.