Clinical management and outcomes in severe COVID-19: acute respiratory distress syndrome across two waves.
Vanessa Cláudia Souza Borba, Simone Cristina Soares Brandão, Lúcia Helena de Oliveira Cordeiro and 6 others
PMID 40548562WHAT IT FOUND
Mortality was more than double in the first wave compared with the second wave among patients with severe COVID-19 ARDS.
Second-wave patients had less organ dysfunction and less invasive ventilation or hemodialysis.
Key findings
01Mortality was more than double in the first wave compared with the second wave (p = 0.001).
02Second-wave patients had lower 24-hour and 72-hour scores for organ dysfunction (p = 0.001).
03First-wave patients were more likely to receive invasive mechanical ventilation (68.4% vs 45.7%, p = 0.002) and hemodialysis (49.5% vs 17.7%, p = 0.000), while second-wave patients were more likely to receive non-invasive ventilation (8.4% vs 72.5%, p = 0.000) and corticosteroids (86.3% vs 96.3%, p = 0.022).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Single-centre study at one university hospital ICU, so it may not apply to other hospitals or health systems. Small sample, with 176 patients analysed. Not randomised, so it cannot show that any treatment caused the mortality difference. Many factors changed between waves at once, including patient severity, organ dysfunction, ICU structure, team experience, and treatment patterns, so the contribution of any single component cannot be separated. No laboratory data, initial symptoms, or viral genotype were collected. Vaccination was very limited in the second wave, with only 7 fully vaccinated patients, so it cannot explain much of the mortality difference.
Declared interests
The study was financed in part by CNPq process 401923/2024-0. The paper does not report other conflicts of interest.
The easy way to misread this
Do not read the lower second-wave mortality as proof that any treatment change worked. The study was not randomised, and patients could receive oxygen catheter, non-rebreather mask, non-invasive ventilation, invasive mechanical ventilation, tracheostomy, vasoactive drugs, hemodialysis, prone and alveolar recruitment maneuvers, corticosteroids, immunosuppressants, heparin, sedatives, neuromuscular blockers, oseltamivir, ivermectin, and antibiotics, so the effect of any single component cannot be separated.