ICU Outcomes in Patients with Covid-19 Associated ARDS: A Retrospective Analysis

Introduction: Acute respiratory distress syndrome (ARDS) management in the intensive care unit (ICU) has been debated since the start of the Covid-19 pandemic. Our study aims to describe the outcomes and predictors of mortality of ARDS associated with Covid-19 within one university-based healthcare system. Methods: This was a retrospective study performed within one university-based healthcare system. An electronic medical record was used to identify 166 patients admitted to the ICU for ARDS in the setting of SARS-CoV-2 infection at three different hospitals. Baseline patient characteristics, ICU and hospital course information, ICU interventions, ventilator settings, and hospital complications were collected and analyzed using descriptive statistical techniques. Results: The 166 patients meeting inclusion criteria had an average age of 64.1 (± 14.8). No significant difference in mortality was identified with male vs. female gender (57.9% vs. 42.1%, p=0.852) or BMI (8.4 ± 0.9 vs. 12.1 ± 1.5, p=0.727). The majority of the patient cohort was identified as black (68.2%). The overall mortality of our cohort was 38.2%. Hyperlipidemia (p=0.011), coronary artery disease (0.034), and chronic obstructive pulmonary disease (p=0.006) were all associated with higher mortality. Prone positioning was utilized in 42.8% of all patients, and ECMO in 6.0%. There was a significant difference of mortality between those with higher observed ventilator plateau pressures at 24 hours (25.7 vs. 23.1, p=0.010) and driving pressures at 24 hours (13.4 vs. 11.7, p=0.036). Conclusion: Covid-19 associated ARDS is associated with significant mortality. Physicians should be aware of pre-existing conditions that are potentially associated with worse outcomes so that they receive appropriate level of care in a timely manner. Lower plateau and driving pressures were associated with improved outcomes. Prospective studies are needed to guide Covid-19 associated ARDS management.