Outcomes in Temporary ICUs Versus Conventional ICUs: An Observational Cohort of Mechanically Ventilated Patients With COVID-19-Induced Acute Respiratory Distress Syndrome
IMPORTANCE: Throughout the COVID-19 pandemic, thousands of temporary ICUs have been established worldwide. The outcomes and management of mechanically ventilated patients in these areas remain unknown. OBJECTIVES: To investigate mortality and management of mechanically ventilated patients in tempora...
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Published in | Critical care explorations Vol. 4; no. 4; p. e0668 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Hagerstown, MD
Lippincott Williams & Wilkins
01.04.2022
Wolters Kluwer |
Subjects | |
Online Access | Get full text |
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Abstract | IMPORTANCE:
Throughout the COVID-19 pandemic, thousands of temporary ICUs have been established worldwide. The outcomes and management of mechanically ventilated patients in these areas remain unknown.
OBJECTIVES:
To investigate mortality and management of mechanically ventilated patients in temporary ICUs.
DESIGN, SETTING, AND PARTICIPANTS:
Observational cohort study in a single-institution academic center. We included all adult patients with severe COVID-19 hospitalized in temporary and conventional ICUs for invasive mechanical ventilation due to acute respiratory distress syndrome from March 23, 2020, to April 5, 2021.
MAIN OUTCOMES AND MEASURES:
To determine if management in temporary ICUs increased 30-day in-hospital mortality compared with conventional ICUs. Ventilator-free days, ICU-free days (both at 28 d), hospital length of stay, and ICU readmission were also assessed.
RESULTS:
We included 776 patients (326 conventional and 450 temporary ICUs). Thirty-day in-hospital unadjusted mortality (28.8% conventional vs 36.0% temporary, log-rank test p = 0.023) was higher in temporary ICUs. After controlling for potential confounders, hospitalization in temporary ICUs was an independent risk factor associated with mortality (hazard ratio, 1.4; CI, 1.06-1.83; p = 0.016).There were no differences in ICU-free days at 28 days (6; IQR, 0-16 vs 2; IQR, 0-15; p = 0.5) or ventilator-free days at 28 days (8; IQR, 0-16 vs 5; IQR, 0-15; p = 0.6). We observed higher reintubation (18% vs 12%; p = 0.029) and readmission (5% vs 1.6%; p = 0.004) rates in conventional ICUs despite higher use of postextubation noninvasive mechanical ventilation (13% vs 8%; p = 0.025). Use of lung-protective ventilation (87% vs 85%; p = 0.5), prone positioning (76% vs 79%; p = 0.4), neuromuscular blockade (96% vs 98%; p = 0.4), and COVID-19 pharmacologic treatment was similar.
CONCLUSIONS AND RELEVANCE:
We observed a higher 30-day in-hospital mortality in temporary ICUs. Although both areas had high adherence to evidence-based management, hospitalization in temporary ICUs was an independent risk factor associated with mortality. |
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AbstractList | Throughout the COVID-19 pandemic, thousands of temporary ICUs have been established worldwide. The outcomes and management of mechanically ventilated patients in these areas remain unknown.
To investigate mortality and management of mechanically ventilated patients in temporary ICUs.
Observational cohort study in a single-institution academic center. We included all adult patients with severe COVID-19 hospitalized in temporary and conventional ICUs for invasive mechanical ventilation due to acute respiratory distress syndrome from March 23, 2020, to April 5, 2021.
To determine if management in temporary ICUs increased 30-day in-hospital mortality compared with conventional ICUs. Ventilator-free days, ICU-free days (both at 28 d), hospital length of stay, and ICU readmission were also assessed.
We included 776 patients (326 conventional and 450 temporary ICUs). Thirty-day in-hospital unadjusted mortality (28.8% conventional vs 36.0% temporary, log-rank test
= 0.023) was higher in temporary ICUs. After controlling for potential confounders, hospitalization in temporary ICUs was an independent risk factor associated with mortality (hazard ratio, 1.4; CI, 1.06-1.83;
= 0.016).There were no differences in ICU-free days at 28 days (6; IQR, 0-16 vs 2; IQR, 0-15;
= 0.5) or ventilator-free days at 28 days (8; IQR, 0-16 vs 5; IQR, 0-15;
= 0.6). We observed higher reintubation (18% vs 12%;
= 0.029) and readmission (5% vs 1.6%;
= 0.004) rates in conventional ICUs despite higher use of postextubation noninvasive mechanical ventilation (13% vs 8%;
= 0.025). Use of lung-protective ventilation (87% vs 85%;
= 0.5), prone positioning (76% vs 79%;
= 0.4), neuromuscular blockade (96% vs 98%;
= 0.4), and COVID-19 pharmacologic treatment was similar.
We observed a higher 30-day in-hospital mortality in temporary ICUs. Although both areas had high adherence to evidence-based management, hospitalization in temporary ICUs was an independent risk factor associated with mortality. IMPORTANCE:. Throughout the COVID-19 pandemic, thousands of temporary ICUs have been established worldwide. The outcomes and management of mechanically ventilated patients in these areas remain unknown. OBJECTIVES:. To investigate mortality and management of mechanically ventilated patients in temporary ICUs. DESIGN, SETTING, AND PARTICIPANTS:. Observational cohort study in a single-institution academic center. We included all adult patients with severe COVID-19 hospitalized in temporary and conventional ICUs for invasive mechanical ventilation due to acute respiratory distress syndrome from March 23, 2020, to April 5, 2021. MAIN OUTCOMES AND MEASURES:. To determine if management in temporary ICUs increased 30-day in-hospital mortality compared with conventional ICUs. Ventilator-free days, ICU-free days (both at 28 d), hospital length of stay, and ICU readmission were also assessed. RESULTS:. We included 776 patients (326 conventional and 450 temporary ICUs). Thirty-day in-hospital unadjusted mortality (28.8% conventional vs 36.0% temporary, log-rank test p = 0.023) was higher in temporary ICUs. After controlling for potential confounders, hospitalization in temporary ICUs was an independent risk factor associated with mortality (hazard ratio, 1.4; CI, 1.06–1.83; p = 0.016).There were no differences in ICU-free days at 28 days (6; IQR, 0–16 vs 2; IQR, 0–15; p = 0.5) or ventilator-free days at 28 days (8; IQR, 0–16 vs 5; IQR, 0–15; p = 0.6). We observed higher reintubation (18% vs 12%; p = 0.029) and readmission (5% vs 1.6%; p = 0.004) rates in conventional ICUs despite higher use of postextubation noninvasive mechanical ventilation (13% vs 8%; p = 0.025). Use of lung-protective ventilation (87% vs 85%; p = 0.5), prone positioning (76% vs 79%; p = 0.4), neuromuscular blockade (96% vs 98%; p = 0.4), and COVID-19 pharmacologic treatment was similar. CONCLUSIONS AND RELEVANCE:. We observed a higher 30-day in-hospital mortality in temporary ICUs. Although both areas had high adherence to evidence-based management, hospitalization in temporary ICUs was an independent risk factor associated with mortality. IMPORTANCE: Throughout the COVID-19 pandemic, thousands of temporary ICUs have been established worldwide. The outcomes and management of mechanically ventilated patients in these areas remain unknown. OBJECTIVES: To investigate mortality and management of mechanically ventilated patients in temporary ICUs. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study in a single-institution academic center. We included all adult patients with severe COVID-19 hospitalized in temporary and conventional ICUs for invasive mechanical ventilation due to acute respiratory distress syndrome from March 23, 2020, to April 5, 2021. MAIN OUTCOMES AND MEASURES: To determine if management in temporary ICUs increased 30-day in-hospital mortality compared with conventional ICUs. Ventilator-free days, ICU-free days (both at 28 d), hospital length of stay, and ICU readmission were also assessed. RESULTS: We included 776 patients (326 conventional and 450 temporary ICUs). Thirty-day in-hospital unadjusted mortality (28.8% conventional vs 36.0% temporary, log-rank test p = 0.023) was higher in temporary ICUs. After controlling for potential confounders, hospitalization in temporary ICUs was an independent risk factor associated with mortality (hazard ratio, 1.4; CI, 1.06-1.83; p = 0.016).There were no differences in ICU-free days at 28 days (6; IQR, 0-16 vs 2; IQR, 0-15; p = 0.5) or ventilator-free days at 28 days (8; IQR, 0-16 vs 5; IQR, 0-15; p = 0.6). We observed higher reintubation (18% vs 12%; p = 0.029) and readmission (5% vs 1.6%; p = 0.004) rates in conventional ICUs despite higher use of postextubation noninvasive mechanical ventilation (13% vs 8%; p = 0.025). Use of lung-protective ventilation (87% vs 85%; p = 0.5), prone positioning (76% vs 79%; p = 0.4), neuromuscular blockade (96% vs 98%; p = 0.4), and COVID-19 pharmacologic treatment was similar. CONCLUSIONS AND RELEVANCE: We observed a higher 30-day in-hospital mortality in temporary ICUs. Although both areas had high adherence to evidence-based management, hospitalization in temporary ICUs was an independent risk factor associated with mortality. Throughout the COVID-19 pandemic, thousands of temporary ICUs have been established worldwide. The outcomes and management of mechanically ventilated patients in these areas remain unknown. Throughout the COVID-19 pandemic, thousands of temporary ICUs have been established worldwide. The outcomes and management of mechanically ventilated patients in these areas remain unknown.Throughout the COVID-19 pandemic, thousands of temporary ICUs have been established worldwide. The outcomes and management of mechanically ventilated patients in these areas remain unknown.To investigate mortality and management of mechanically ventilated patients in temporary ICUs.OBJECTIVESTo investigate mortality and management of mechanically ventilated patients in temporary ICUs.Observational cohort study in a single-institution academic center. We included all adult patients with severe COVID-19 hospitalized in temporary and conventional ICUs for invasive mechanical ventilation due to acute respiratory distress syndrome from March 23, 2020, to April 5, 2021.DESIGN SETTING AND PARTICIPANTSObservational cohort study in a single-institution academic center. We included all adult patients with severe COVID-19 hospitalized in temporary and conventional ICUs for invasive mechanical ventilation due to acute respiratory distress syndrome from March 23, 2020, to April 5, 2021.To determine if management in temporary ICUs increased 30-day in-hospital mortality compared with conventional ICUs. Ventilator-free days, ICU-free days (both at 28 d), hospital length of stay, and ICU readmission were also assessed.MAIN OUTCOMES AND MEASURESTo determine if management in temporary ICUs increased 30-day in-hospital mortality compared with conventional ICUs. Ventilator-free days, ICU-free days (both at 28 d), hospital length of stay, and ICU readmission were also assessed.We included 776 patients (326 conventional and 450 temporary ICUs). Thirty-day in-hospital unadjusted mortality (28.8% conventional vs 36.0% temporary, log-rank test p = 0.023) was higher in temporary ICUs. After controlling for potential confounders, hospitalization in temporary ICUs was an independent risk factor associated with mortality (hazard ratio, 1.4; CI, 1.06-1.83; p = 0.016).There were no differences in ICU-free days at 28 days (6; IQR, 0-16 vs 2; IQR, 0-15; p = 0.5) or ventilator-free days at 28 days (8; IQR, 0-16 vs 5; IQR, 0-15; p = 0.6). We observed higher reintubation (18% vs 12%; p = 0.029) and readmission (5% vs 1.6%; p = 0.004) rates in conventional ICUs despite higher use of postextubation noninvasive mechanical ventilation (13% vs 8%; p = 0.025). Use of lung-protective ventilation (87% vs 85%; p = 0.5), prone positioning (76% vs 79%; p = 0.4), neuromuscular blockade (96% vs 98%; p = 0.4), and COVID-19 pharmacologic treatment was similar.RESULTSWe included 776 patients (326 conventional and 450 temporary ICUs). Thirty-day in-hospital unadjusted mortality (28.8% conventional vs 36.0% temporary, log-rank test p = 0.023) was higher in temporary ICUs. After controlling for potential confounders, hospitalization in temporary ICUs was an independent risk factor associated with mortality (hazard ratio, 1.4; CI, 1.06-1.83; p = 0.016).There were no differences in ICU-free days at 28 days (6; IQR, 0-16 vs 2; IQR, 0-15; p = 0.5) or ventilator-free days at 28 days (8; IQR, 0-16 vs 5; IQR, 0-15; p = 0.6). We observed higher reintubation (18% vs 12%; p = 0.029) and readmission (5% vs 1.6%; p = 0.004) rates in conventional ICUs despite higher use of postextubation noninvasive mechanical ventilation (13% vs 8%; p = 0.025). Use of lung-protective ventilation (87% vs 85%; p = 0.5), prone positioning (76% vs 79%; p = 0.4), neuromuscular blockade (96% vs 98%; p = 0.4), and COVID-19 pharmacologic treatment was similar.We observed a higher 30-day in-hospital mortality in temporary ICUs. Although both areas had high adherence to evidence-based management, hospitalization in temporary ICUs was an independent risk factor associated with mortality.CONCLUSIONS AND RELEVANCEWe observed a higher 30-day in-hospital mortality in temporary ICUs. Although both areas had high adherence to evidence-based management, hospitalization in temporary ICUs was an independent risk factor associated with mortality. |
Author | Gonzalez-Lara, María Fernanda Gutierrez-Espinoza, Irving Rene Jasso-Molina, Juan C. Kershenobich, David Jimenez, Jose Victor Martínez-Guerra, Bernardo A. Najera-Ortíz, María Paula Hyzy, Robert C. Dardón-Fierro, Francisco Eduardo Morales-Paredes, Luis Alberto Ponce de León-Garduño, Alfredo Martínez-Becerril, Marina Gil- López, Fernando Rodríguez-Crespo, Juan José Olivas-Martinez, Antonio Sifuentes-Osornio, José Alvarado-Avila, Pedro E. Dominguez-Cherit, Guillermo Juárez-Meneses, Noé Alonso Ayala-Aguillón, Frida Chávez-Suárez, Adriana Rios-Olais, Fausto Alfredo Román-Montes, Carla Marina Leal-Villarreal, Mario Andrés de Jesús Baltazar-Torres, José Ángel Enamorado-Cerna, Linda Rivero-Sigarroa, Eduardo |
Author_xml | – sequence: 1 givenname: Jose Victor surname: Jimenez fullname: Jimenez, Jose Victor organization: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI – sequence: 2 givenname: Antonio surname: Olivas-Martinez fullname: Olivas-Martinez, Antonio organization: Department of Biostatistics, University of Washington, Seattle, WA – sequence: 3 givenname: Fausto Alfredo surname: Rios-Olais fullname: Rios-Olais, Fausto Alfredo organization: Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 4 givenname: Frida surname: Ayala-Aguillón fullname: Ayala-Aguillón, Frida organization: Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 5 givenname: Fernando surname: Gil- López fullname: Gil- López, Fernando organization: Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 6 givenname: Mario Andrés de Jesús surname: Leal-Villarreal fullname: Leal-Villarreal, Mario Andrés de Jesús organization: Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 7 givenname: Juan José surname: Rodríguez-Crespo fullname: Rodríguez-Crespo, Juan José organization: Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 8 givenname: Juan C. surname: Jasso-Molina fullname: Jasso-Molina, Juan C. organization: Department of Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 9 givenname: Linda surname: Enamorado-Cerna fullname: Enamorado-Cerna, Linda organization: Department of Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 10 givenname: Francisco Eduardo surname: Dardón-Fierro fullname: Dardón-Fierro, Francisco Eduardo organization: Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 11 givenname: Bernardo A. surname: Martínez-Guerra fullname: Martínez-Guerra, Bernardo A. organization: Department of Infectious Disease, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 12 givenname: Carla Marina surname: Román-Montes fullname: Román-Montes, Carla Marina organization: Department of Infectious Disease, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 13 givenname: Pedro E. surname: Alvarado-Avila fullname: Alvarado-Avila, Pedro E. organization: Department of Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 14 givenname: Noé Alonso surname: Juárez-Meneses fullname: Juárez-Meneses, Noé Alonso organization: Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 15 givenname: Luis Alberto surname: Morales-Paredes fullname: Morales-Paredes, Luis Alberto organization: Department of Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 16 givenname: Adriana surname: Chávez-Suárez fullname: Chávez-Suárez, Adriana organization: Department of Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 17 givenname: Irving Rene surname: Gutierrez-Espinoza fullname: Gutierrez-Espinoza, Irving Rene organization: Department of Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 18 givenname: María Paula surname: Najera-Ortíz fullname: Najera-Ortíz, María Paula organization: Department of Nursing, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 19 givenname: Marina surname: Martínez-Becerril fullname: Martínez-Becerril, Marina organization: Department of Nursing, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 20 givenname: María Fernanda surname: Gonzalez-Lara fullname: Gonzalez-Lara, María Fernanda organization: Department of Infectious Disease, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 21 givenname: Alfredo surname: Ponce de León-Garduño fullname: Ponce de León-Garduño, Alfredo organization: Department of Infectious Disease, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 22 givenname: José Ángel surname: Baltazar-Torres fullname: Baltazar-Torres, José Ángel organization: Department of Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 23 givenname: Eduardo surname: Rivero-Sigarroa fullname: Rivero-Sigarroa, Eduardo organization: Department of Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico – sequence: 24 givenname: Guillermo surname: Dominguez-Cherit fullname: Dominguez-Cherit, Guillermo organization: Escuela de Medicina y Ciencias de la Salud TecSalud del Tecnológico de Monterrey, Monterrey, Mexico – sequence: 25 givenname: Robert C. surname: Hyzy fullname: Hyzy, Robert C. organization: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI – sequence: 26 givenname: David surname: Kershenobich fullname: Kershenobich, David organization: Escuela de Medicina y Ciencias de la Salud TecSalud del Tecnológico de Monterrey, Monterrey, Mexico – sequence: 27 givenname: José surname: Sifuentes-Osornio fullname: Sifuentes-Osornio, José organization: Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/35372841$$D View this record in MEDLINE/PubMed |
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Copyright | Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. 2022 |
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Keywords | COVID-19 acute respiratory distress syndrome mortality intensive care unit mechanical ventilation acute lung injury |
Language | English |
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Notes | Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccejournal). Drs. Jimenez and Sifuentes-Osornio conceptualized and designed the study as well interpreted and analyzed the results of this study. Dr. Olivas-Martinez analyzed, interpreted, and elaborated the figures for this study. Drs. Jimenez, Rios-Olais, Ayala-Aguillón, Gil- López, Leal-Villarreal, Rodríguez-Crespo, Jasso-Molina, Enamorado-Cerna, Dardón-Fierro, Martínez-Guerra, Román-Montes, Alvarado-Avila, Juárez-Meneses, Morales-Paredes, Chávez-Suárez, Gutierrez-Espinoza, and Hyzy contributed to the study design, data collection and interpretation, and the writing of the article. Drs. Jimenez, Najera-Ortíz, Martínez-Becerril, Gonzalez-Lara, Ponce de León-Garduño, Baltazar-Torres, Rivero-Sigarroa, Dominguez-Cherit, Hyzy, and Kershenobich contributed to the article's data interpretation, analysis, and writing. Dr. Hyzy serves on the advisory board for Merck, Boehringer Ingelheim, consultant for Cour Pharmaceuticals, and NOTA-Laboratories. He has textbook royalties from Springer Website and UpToDate Grants: CHEST Foundation, National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Network Medicolegal Expert witness work. The remaining authors have disclosed that they do not have any potential conflicts of interest. The datasets used and analyzed in this study are available from the corresponding author on reasonable request. For information regarding this article, E-mail: jose.sifuenteso@incmnsz.mx ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
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PublicationDate | 2022-04-01 |
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PublicationTitle | Critical care explorations |
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Throughout the COVID-19 pandemic, thousands of temporary ICUs have been established worldwide. The outcomes and management of mechanically... Throughout the COVID-19 pandemic, thousands of temporary ICUs have been established worldwide. The outcomes and management of mechanically ventilated patients... IMPORTANCE:. Throughout the COVID-19 pandemic, thousands of temporary ICUs have been established worldwide. The outcomes and management of mechanically... |
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Title | Outcomes in Temporary ICUs Versus Conventional ICUs: An Observational Cohort of Mechanically Ventilated Patients With COVID-19-Induced Acute Respiratory Distress Syndrome |
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