Evaluating Management and Clinical Outcomes of Patients Admitted With Covid-19 Associated Acute Respiratory Distress Syndrome at the Aga Khan University Hospital

Abstract

Study Background: The Covid 19- pandemic has seen a surge of patients with ARDS across many intensive care units globally. While most people with Covid 19 infections develop only mild or uncomplicated disease, the World Health Organization (WHO) reports that 14 % develop severe disease requiring hospitalization and are in need of oxygen support, and 5% develop ARDS and do need admission into ICU for respiratory support. Broad objective: To evaluate the management and clinical outcomes of patients admitted with Covid 19 Associated Acute Respiratory Distress Syndrome at the Aga Khan University Hospital Intensive Care Unit Expected benefits of the study/utility of the study: The study was meant to provide information regarding different outcomes in relation to the management methods used in treating patients with varying severity of Covid-19 ARDS. Methodology: The study was a retrospective descriptive cohort study that was done at the Aga Khan University Hospital Nairobi at the intensive care unit. Census was done on all the 201 patient files admitted with severe Covid -19 pneumonia who developed ARDS, from March 2020 to December 2020. A Data extraction tool was used to extract data from medical records. Data collected included initial assessment, demographics, severity score on admission, diagnostic test results, mode of mechanical ventilation, length of ICU stay and discharge status. Descriptive analysis was done through the use of percentages and standard deviation while inferential analysis included the tests of association between mortality rates and mode of mechanical ventilation. The study findings: The demographic factors; age and gender had a significant association with disease outcomes among the CARDS Patients. Male patients tended to have worse outcomes and so did older patients. The Sequential Organ Failure Assessment (SOFA) score on admission had quite a significant association with patient outcomes: (r=368, P< .05) Acute Physiology and Chronic Health Disease Classification System II (APACHE) score on the other hand did not have a significant association with disease outcome: (r=.014, P>.873) The study findings indicated both non-invasive and invasive treatment modalities significantly influenced outcomes among COVID 19 associated ARDS. Additionally the findings established a high probability of survival of patients on non-invasive ventilation, 56.7%, compared to invasive mechanical ventilation with a 43.3% survival rate. Also, results indicate Pearson Chi-Square (X2, 33.419; P<.000); which showed that there was a significance difference in the outcome. Study Recommendations: While invasive and non-invasive methods remain the effective methods in the treatment of CARDS, there is need for to consider the best method of treatment that can reduce the percentage of possible deaths given that the highest death outcomes were with the Invasive mechanical ventilation. There is currently no specific tool for evaluating COVID 19 infections, and the medical team continues to use the existing tools of SOFA score and APACHE score as heighted by Attaway et al. (2021), therefore there is need for more research on better tools for better prediction of the patients with COVID-19 associated acute respiratory distress syndrome.