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The death rate among COVID-19 patients in intensive care has fallen since the start of the pandemic, largely because of better treatments. But a new study review suggests that those advances in care may have plateaued.
The new analysis looked at data from 52 studies in North America, Europe, China and elsewhere, conducted up to October 2020 and including more than 43,000 patients.
There was good news: The researchers found that the death rate for COVID-19 patients admitted to ICUs had fallen by 36% compared to death rates seen in a prior study released in July.
Already, in that earlier analysis, deaths among COVID-19 patients treated in ICUs had fallen from almost 60% at the end of March to 42% at the end of May -- a decrease of about one-third.
However, while the new data suggests that ICU outcomes are still improving, the pace of progress has slowed substantially, according to researchers led by Dr. Tim Cook. He's professor and consultant in anesthesia and intensive care medicine at Royal United Hospitals Bath NHS Foundation Trust in the United Kingdom.
"After our first meta-analysis last year showed a large drop in ICU mortality from COVID-19 from March to May 2020, this updated analysis shows that any fall in mortality rate between June and October 2020 appears to have flattened or plateaued," Cook's team concluded.
Over the last few months, several studies have identified which treatments do and do not benefit COVID-19 patients in the ICU, the researchers said.
For example, in early June, steroids (particularly dexamethasone) were shown to improve survival in patients who are oxygen-dependent or receiving mechanical respiratory support. But other once-promising drugs -- including hydroxychloroquine, azithromycin, lopinavir/ritonavir and remdesivir -- have been found to have no clear benefit, the researchers said.
On the other hand, the non-pharmaceutical management of COVID-19 -- things such as oxygen therapy, fluid therapy and management of blood clotting -- has improved since the start of the pandemic, Cook and colleagues said. The findings were published Feb. 1 in the journal Anaesthesia.
Dr. Mangala Narasimhan directs critical care services at Northwell Health in New Hyde Park, N.Y. She wasn't involved in the new report, but agreed that there's been a winnowing out of various therapies.
For example, "we know that medications to prevent the patients' immune response from overreacting after being placed on a ventilator do not work and can increase the infection rate," Narasimhan said.
As well, more patients are avoiding mechanical ventilators, staying on supplemental oxygen instead, "and this is lowering mortality [deaths]," she said. "Of those that progress and get worse and get intubated, the mortality is actually higher.
"We also know this should be treated like regular respiratory distress syndrome [severe pneumonia], with lung protective ventilation," Narasimhan said, adding that "we did not know this in the spring," when the pandemic began.
There is one ominous cloud on the horizon, however: The emergence on new coronavirus variants, such as the British or South African variants, that could add to treatment difficulties.
"Our analysis includes studies published only up to October 2020," Cook's group said in a journal news release. "Since then, several variant viruses have emerged and in some countries transformed the trajectory of the pandemic through December 2020 and into January 2021.
"This has increased the demand on ICU in those locations and will merit further analysis in due course," the researchers added. "To counter this, vaccination is now available in many countries and we can hope that this will also, over several months, positively impact on the pandemic trajectory and demand on ICU care."
SOURCES: Mangala Narasimhan, DO, director, critical care services, Northwell Health, New Hyde Park, N.Y.; Anaesthesia, news release, Feb. 1, 2021
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