Staff Preparedness as an Independent Factor for Death in Patients with Severe Acute Respiratory Syndrome Admitted to an Intensive Care Unit During COVID-19 Pandemic: An Observational Cohort Study

Background: Since March 2020, WHO declared a pandemic of COVID-19 and the world is facing an unprecedented challenge. Several regions have been forced to increase intensive care unit (ICU) capacity in a short period of time to deal with an expressive number of critically ill patients. This study aims to evaluate the impact of staff preparedness by comparing the outcomes between two ICUs units from the same hospital, one previously well-established and one recently assembled to deal with a markedly increased volume of patients brought by COVID-19 pandemic.Methods: This is an observational cohort study with retrospective collection of data, conducted in Instituto de Infectologia Emílio Ribas, São Paulo-SP, Brazil. We included all patients who were admitted to an ICU with suspected COVID-19, from March 1st until April 30th, 2020. The assessed outcome was the rate of in-hospital mortality.Findings: 114 cases with severe acute respiratory syndrome were included.The median age was 57 years, with a male predominance. More than half of patients had at least one comorbidity, hypertension, diabetes or obesity. Data on respiratory pathogens were available for 112 patients, of whom 86 (77%) had a SARS-CoV-2 confirmed by polymerase chain reaction (PCR) and 4 (4%) tested positive for influenza, also by PCR method. Age > 60 years, need of invasive mechanical ventilation and an ICU type (recently assembled) were independently associated with in-hospital mortality among patients with severe acute respiratory syndrome during the COVID-19 pandemic.Interpretation: This finding highlights the importance of considering the ICU type as a possible determinant of mortality during an epidemic, together with the already well-described risk factors of age and comorbidities, suggesting that we should develop support strategies for recently assembled ICUs, as training and mentorship programs.Funding: This study has no sponsor.Declaration of Interests: The authors have nothing to disclose.Ethics Approval Statement: The National Research and Ethics Commission (CONEP) approved this study (CAAE 30632820.2.0000.0061).