Six-Month Post-Intensive Care Outcomes During High and Low Bed Occupancy due to the COVID-19 Pandemic: a Multicenter Prospective Cohort Study

Abstract

Abstract Purpose: The COVID-19 pandemic can be seen as a natural experiment to test how bed occupancy affects post-intensive care unit (ICU) patient's functional outcomes. Therefore, we compared by bed occupancy the frequency of mental, physical, and cognitive impairments in patients admitted to ICU during the COVID-19 pandemic. Methods: Prospective cohort of adults mechanically ventilated >48 hours in one of 19 ICUs in seven Chilean public and private hospitals. Ninety per cent of nationwide beds occupied was the cut-off for low versus high bed occupancy. At ICU discharge, 3- and 6-month follow-up, we assessed disability using the World Health Organization Disability Assessment Schedule 2.0, quality of life, mental, physical, and cognitive outcomes following the core outcome set for acute respiratory failure. Results: 252 eligible participants were enrolled, 103(41%) during low and 149(59%) during high occupancy. Patients treated during high occupancy were younger (P50[P25-P75]: 55[44-63] vs 61[51-71]; p<0.001), more likely to be admitted due to COVID-19 (126[85%] vs 65[63%]; p<0.001), and have higher education qualification (94[63%] vs 48[47%]; p=0.03). No differences were found in the frequency of at least one mental, physical or cognitive impairment by bed occupancy at ICU discharge (low vs high: 93% vs 91%; p=0.6), 3-month (74% vs 63%; p=0.2) and 6-month (57% vs 57%; p=0.9) follow-up. Conclusions: There were no differences in post-ICU outcomes between high and low bed occupancy. Most patients had at least one mental, physical or cognitive impairment at ICU discharge, which remained high at 6-month follow-up.