• Karl Stattin, Robert Frithiof, Michael Hultström, Miklos Lipcsey, and Rafael Kawati.
• From the Department of Surgical Sciences, Anaesthesia and Intensive Care (KS, RF, MH, ML, RK), Department of Medical Cell Biology, Integrative Physiology, Uppsala University, Uppsala, Sweden (MH), Department of Epidemiology, McGill University (MH), Lady Davis Institute of Medical Research, Jewish General Hospital, Montréal, Quebec, Canada (MH), and Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (ML).
• Eur J Anaesthesiol. 2023 Jan 1; 40 (1): 132013-20.

BackgroundThe Coronavirus 2019 (COVID-19) pandemic has led to an unprecedented strain on the ICU resources. It is not known how the ICU resources employed in treating COVID-19 patients are related to inpatient characteristics, use of organ support or mortality.ObjectivesTo investigate how the use of ICU resources relate to use of organ support and mortality in COVID-19 patients.DesignA national register-based cohort study.SettingAll Swedish ICUs from March 2020 to November 2021.PatientsAll patients admitted to Swedish ICUs with a primary diagnosis of COVID-19 reported to the national Swedish Intensive Care Register (SIR).Main Outcome MeasuresOrgan support (mechanical ventilation, noninvasive ventilation, high-flow oxygen therapy, prone positioning, surgical and percutaneous tracheostomy, central venous catheterisation, continuous renal replacement therapy and intermittent haemodialysis), discharge at night, re-admission, transfer and ICU and 30-day mortality.ResultsSeven thousand nine hundred and sixty-nine patients had a median age of 63 years, and 70% were men. Median daily census was 167% of habitual census, daily new admissions were 20% of habitual census and the median occupancy was 82%. Census and new admissions were associated with mechanical ventilation, OR 1.37 (95% CI 1.28 to 1.48) and OR 1.44 (95% CI 1.13 to 1.84), respectively, but negatively associated with noninvasive ventilation, OR 0.83 (95% CI 0.77 to 0.89) and OR 0.40 (95% CI 0.30 to 52) and high-flow oxygen therapy, OR 0.72 (95% CI 0.67 to 0.77) and OR 0.77 (95% CI 0.61 to 0.97). Occupancy above 90% of available beds was not associated with mechanical ventilation or noninvasive ventilation, but with high-flow oxygen therapy, OR 1.36 (95% CI 1.21 to 1.53). All measures of pressure on resources were associated with transfer to other hospitals, but none were associated with discharge at night, ICU mortality or 30-day mortality.ConclusionsPressure on ICU resources was associated with more invasive respiratory support, indicating that during these times, ICU resources were reserved for sicker patients.Copyright © 2022 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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