Real World Characteristics and Outcomes of COVID-19 patients admitted to Argentinean ICUs

A fresh perspective on the COVID-19 pandemic in Argentina!

Since emerged in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing Coronavirus disease 2019 (COVID-19) has quickly widespread overwhelming global healthcare systems.

Initially, reviews containing characteristics and outcomes of severe COVID-19 patients requiring admission to an Intensive Care Unit (ICU) came from China, Europe (Italy, Spain), and the United States. However, little is known from low-to-middle-income countries (LMIC), especially in Latin America.

A recently published article atTheLancet Respiratory Medicine entitled: “The Clinical characteristics and outcomes of invasively ventilated patients with COVID-19 in Argentina: a prospective, multicenter cohort study” provided the first prospective multicenter perspective carried out in an LMIC. SATICOVID Study conducted through the Argentinean Critical Care Society (SATI - Sociedad Argentina de Terapia Intensiva) involved 1909 patients mechanically ventilated with RT-PCR confirmed COVID-19 disease across 63 Argentinean ICUs during 2020.

Led by pioneer Argentinean Intensivist Elisa Estenssoro MD, the study demographics showed predominantly male patients, aged 62, with frequent comorbidities like hypertension, obesity, diabetes, and previous respiratory diseases; only 8% of patients had no preexistent conditions.

In this cohort of patients, 22% underwent endotracheal intubation before ICU admission, 49% required vasopressors on the first day of ICU admission, and lung-protective ventilation was widely employed. A high rate of complications was observed: acute respiratory distress syndrome (88%), acute kidney injury (52%, of which 20% required renal replacement therapy), bacteremia (21%), and thromboembolic disease (9%).

The mortality rate was 57%, like other Latin American countries. Independent risk factors were age, comorbidities, oxygenation index, ventilatory driving pressure (a variable of respiratory mechanics), acidemia, acute kidney injury, and admission during the months in which cases peaked in Argentina.

SATICOVIDStudy demonstrated a high mortality rate among mechanically ventilated patients, even those with lung-protective measures; it also was correlated in studies carried out in other regions of the world. According to Dr. Estenssoro, identifying the determinants of prognosis in these patients is essential to improve outcomes and ICU resource use.This study also pointed out that the mortality increased with ongoing months of the pandemic; however, the Argentine healthcare system was never overwhelmed, as occurred during the second wave after this study completion. 

An adequate pandemic response should include advanced planning for generating a significant and permanent increase of the vital ICU human resource, as pointed by Elisa Estenssoro and Rosa Reina, SATI's President, and co-author of the study. Given that ICU personnel was very scarce from the beginning of the pandemic and was frequently affected by COVID-19, this probably overwhelmed the healthcare system. However, the quality of care would decrease in overburdened systems.

Apart from being the first article that includes the real-world characteristics and outcomes of patients with COVID-19 requiring ICU in an LMIC, it also highlights the need to reduce the shortage of doctors, nurses, and other related health professionals working in ICUs.

The importance of defining policies, strategies, and protocols that secure immediate availability of human and technology resources, identifying and continuously monitoring, is the key for preparation for the upcoming pandemic waves, as shown by another study carried out by SATI.