Clinical management and outcomes in severe COVID-19: acute respiratory distress syndrome across two waves.

Objective: Analyze changes in epidemiological and prognostic factors, clinical management and the evolutionary impact of these variables on in-hospital outcomes by comparing the first two waves of Acute Respiratory Distress Syndrome (ARDS) due COVID-19 in a university center in Northeastern Brazil.

Method: Patients hospitalized from April 2020 to February 2021 were included in the first wave sample; while the second wave from March to August 2021, according to the rise and fall of cases in Pernambuco. Prospective study where we analyzed the clinical profile, outcomes and treatment in hospitalized patients.

Results: Among 176 patients, 95 were from the first and 81 from the second wave. Mortality was 35,8%, being 47,4% vs. 22,2% (p = 0.001), respectively. Median age was 55 years [IQR:46-58], with no difference between waves. The Sequential Organ Failure Assessment (SOFA) was higher in the first wave, median of 4[IQR: 3;7,7] vs. 3[IQR: 2;5,5], and 5[IQR: 3;8] vs. 3[IQR: 2;7], at 24 and 72 hours, respectively (p = 0.001). Patients in the first wave received more invasive mechanical ventilation (IMV), 68,4% vs. 45,7% (p = 0.002) and hemodialysis, 49,5% vs. 17,7% (p = 0.000), but less non-invasive ventilation (NIV), 8,4% vs. 72,5% (p = 0.000), and corticosteroids, 86,6% vs. 96,6% (p = 0.02). No one was vaccinated in the first wave, while only 7 patients had received a full vaccine in the second wave.

Conclusion: Patients with ARDS had lower mortality, fewer organ dysfunctions and less need for IMV and hemodialysis, with greater use of NIV and corticosteroids in the second wave.