• Alexandre Lopez, Ines Lakbar, Louis Delamarre, Aurélien Culver, Charlotte Arbelot, Gary Duclos, Emmanuelle Hammad, Bruno Pastene, François Antonini, Laurent Zieleskiewicz, and Marc Leone.
• Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Marseille 13015, France. Electronic address: alexandre.lopez@ap-hm.fr.
• J Crit Care. 2021 Oct 1; 65: 200204200-204.

PurposeTo compare the effects of two therapeutic bundles of management in SARS-CoV2 ICU patients.Materials And MethodsOur retrospective, observational study was performed in a university ICU from March to June 2020 (first wave) and from September 2020 to January 2021 (second wave). In first wave, patients received bundle 1 including early invasive ventilation, hydroxychloroquine, cefotaxime and azithromycin. In second wave, bundle 2 included non-invasive oxygenation support and dexamethasone. The main outcome was in-hospital mortality. Secondary outcomes included ICU and hospital length of stay, ICU supportive therapies, viral clearance and antimicrobial resistance emergence.Results129 patients with SARS-CoV-2 pneumonia were admitted to our ICU. Thirty-five were treated according to bundle 1 and 76 to bundle 2. In-hospital mortality was similar in the two groups (23%, p = 1). The hospital (p = 0.003) and ICU (p = 0.01) length of stay and ventilator-free days at 28 days (p = 0.03) were significantly reduced in bundle 2. Increasing age, vasopressor use and PaO2/FiO2 ratio < 125 were associated with in-hospital mortality.ConclusionWithin the limitations of our study, changes in therapeutic bundles for SARS-Cov-2 ICU patients might have no effect on in-hospital mortality but were associated with less exposure to mechanical ventilation and reduced hospital length of stay.Copyright © 2021 Elsevier Inc. All rights reserved.

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