JMIR Publications

ABSTRACT

Background:

In Brazil, the high demand for intensive care unit (ICU) beds during COVID-19 pan-demic caused great social impact. The lack of trained professionals, especially in-tensivists, impelled government and specialists to seek for alternatives to deliver efficient care. In this scenario, the Tele-ICU COVID-19 Brazil program was created to provide remote intensivists to guide daily multidisciplinary rounds (DMRs) in pub-lic COVID-19 ICUs from the country.

Objective:

The objective of the present study was to evaluate the association of the adherence to the Tele-ICU COVID-19 Brazil Program and clinical outcomes of patients with COVID-19.

Methods:

Retrospective study with all the ICUs participants of the Tele-ICU COVID-19 Brazil program. In order to assess the Tele-ICU impact on clinical outcomes, we analyzed the adherence to the program at the patient level, the DMR patient ratio (defined as number of DMRs for each patient divided by patient’s ICU length of stay); at the ICU level, the DMR ICU ratio (defined as DMR-days divided by patient-days) and each ICU’s length of participation in the project. We made comparisons between the groups: Low DMR (〖"DMR" 〗_"patient" " ratio" < 50%) vs high DMR (〖"DMR" 〗_"patient" " ratio" > 50%) and low engagement (〖"DMR" 〗_"patient" " ratio" < 50%) vs high engagement (〖"DMR" 〗_"ICU " "ratio" > 50%). Additionally, we performed multivariate analyses using multilevel mixed modelling to evaluate independent predictors of ICU mortality and ICU length of stay.

Results:

1680 patients were included in the study. Compared to the low DMR group, patients from the high DMR group had shorter ICU [6(3-11) vs 11(6-20) days; p<0.001] and shorter hospital length of stay [9(5-16) vs 14(8-26) days; p<0.001]. However, the SOFA score was higher in the low DMR group [3(0-6) vs 2(0-5) days; p=0.007]. Compared to the low engagement group, patients from the high engagement group, had lower SOFA score [2(0-4) vs 3(1-7) days; p<0.001], lower ICU mortality (45.3% vs 52.2%; p=0.004), shorter ICU length of stay [7 days (4-12) vs 9(5-17) days; p<0.001] and shorter hospital length of stay [8(5-16) vs 14(7-23) days; p<0.001]. The multivariate analysis identified the use of mechanical ventilation (MV), non-invasive ventilation (NIV) and vasopressor as that independently predictors of ICU mortality. In contrast, a higher DMR per patient ratio was found to be a protective factor, associated with a decreased mortality risk (OR: 0.52; 95%CI: 0.27-0.99; p=0.048). Predictors for a longer ICU length of stay were higher SOFA score and the use of MV, while a higher DMR per patient ratio was found to be a protective factor, associated with a shorter ICU stay (OR: 0.17; 95%CI: 0.13-0.21; p<0.001).

Conclusions:

During Tele-ICU COVID-19 Brazil program, patients who received DMRs more fre-quent had lower risk for ICU mortality and shorter ICU length of stays.