• Pedro David Wendel-Garcia, André Moser, Marie-Madlen Jeitziner, Hernán Aguirre-Bermeo, Pedro Arias-Sanchez, Janina Apolo, Ferran Roche-Campo, Diego Franch-Llasat, Gian-Reto Kleger, Claudia Schrag, Urs Pietsch, Miodrag Filipovic, Sascha David, Klaus Stahl, Souad Bouaoud, Amel Ouyahia, Patricia Fodor, Pascal Locher, Martin Siegemund, Nuria Zellweger, Sara Cereghetti, Peter Schott, Gianfilippo Gangitano, Maddalena Alessandra Wu, Mario Alfaro-Farias, Gerardo Vizmanos-Lamotte, Hatem Ksouri, Nadine Gehring, Emanuele Rezoagli, Fabrizio Turrini, Herminia Lozano-Gómez, Andrea Carsetti, Raquel Rodríguez-García, Bernd Yuen, WeberAnja BaltussenABAnaesthesie Und Intensivmedizin, Kantonsspital Baselland, Liestal, Switzerland., Pedro Castro, Jesus Oscar Escos-Orta, Alexander Dullenkopf, Maria C Martín-Delgado, Theodoros Aslanidis, Marie-Helene Perez, Frank Hillgaertner, Samuele Ceruti, Marilene Franchitti Laurent, Julien Marrel, Riccardo Colombo, Marcus Laube, Alberto Fogagnolo, Michael Studhalter, Tobias Wengenmayer, Emiliano Gamberini, Christian Buerkle, Philipp K Buehler, Stefanie Keiser, Muhammed Elhadi, Jonathan Montomoli, Philippe Guerci, Thierry Fumeaux, Reto A Schuepbach, Stephan M Jakob, Yok-Ai Que, Matthias Peter Hilty, and RISC-19-ICU Investigators.
• Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.
• Crit Care. 2022 Jul 4; 26 (1): 199.

BackgroundIt remains elusive how the characteristics, the course of disease, the clinical management and the outcomes of critically ill COVID-19 patients admitted to intensive care units (ICU) worldwide have changed over the course of the pandemic.MethodsProspective, observational registry constituted by 90 ICUs across 22 countries worldwide including patients with a laboratory-confirmed, critical presentation of COVID-19 requiring advanced organ support. Hierarchical, generalized linear mixed-effect models accounting for hospital and country variability were employed to analyse the continuous evolution of the studied variables over the pandemic.ResultsFour thousand forty-one patients were included from March 2020 to September 2021. Over this period, the age of the admitted patients (62 [95% CI 60-63] years vs 64 [62-66] years, p < 0.001) and the severity of organ dysfunction at ICU admission decreased (Sequential Organ Failure Assessment 8.2 [7.6-9.0] vs 5.8 [5.3-6.4], p < 0.001) and increased, while more female patients (26 [23-29]% vs 41 [35-48]%, p < 0.001) were admitted. The time span between symptom onset and hospitalization as well as ICU admission became longer later in the pandemic (6.7 [6.2-7.2| days vs 9.7 [8.9-10.5] days, p < 0.001). The PaO2/FiO2 at admission was lower (132 [123-141] mmHg vs 101 [91-113] mmHg, p < 0.001) but showed faster improvements over the initial 5 days of ICU stay in late 2021 compared to early 2020 (34 [20-48] mmHg vs 70 [41-100] mmHg, p = 0.05). The number of patients treated with steroids and tocilizumab increased, while the use of therapeutic anticoagulation presented an inverse U-shaped behaviour over the course of the pandemic. The proportion of patients treated with high-flow oxygen (5 [4-7]% vs 20 [14-29], p < 0.001) and non-invasive mechanical ventilation (14 [11-18]% vs 24 [17-33]%, p < 0.001) throughout the pandemic increased concomitant to a decrease in invasive mechanical ventilation (82 [76-86]% vs 74 [64-82]%, p < 0.001). The ICU mortality (23 [19-26]% vs 17 [12-25]%, p < 0.001) and length of stay (14 [13-16] days vs 11 [10-13] days, p < 0.001) decreased over 19 months of the pandemic.ConclusionCharacteristics and disease course of critically ill COVID-19 patients have continuously evolved, concomitant to the clinical management, throughout the pandemic leading to a younger, less severely ill ICU population with distinctly different clinical, pulmonary and inflammatory presentations than at the onset of the pandemic.© 2022. The Author(s).

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