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 inCritical care explorations Vol. 4; no. 4; p. e0668
Main Authors Jimenez, Jose Victor, Olivas-Martinez, Antonio, Rios-Olais, Fausto Alfredo, Ayala-Aguillón, Frida, Gil- López, Fernando, Leal-Villarreal, Mario Andrés de Jesús, Rodríguez-Crespo, Juan José, Jasso-Molina, Juan C., Enamorado-Cerna, Linda, Dardón-Fierro, Francisco Eduardo, Martínez-Guerra, Bernardo A., Román-Montes, Carla Marina, Alvarado-Avila, Pedro E., Juárez-Meneses, Noé Alonso, Morales-Paredes, Luis Alberto, Chávez-Suárez, Adriana, Gutierrez-Espinoza, Irving Rene, Najera-Ortíz, María Paula, Martínez-Becerril, Marina, Gonzalez-Lara, María Fernanda, Ponce de León-Garduño, Alfredo, Baltazar-Torres, José Ángel, Rivero-Sigarroa, Eduardo, Dominguez-Cherit, Guillermo, Hyzy, Robert C., Kershenobich, David, Sifuentes-Osornio, José
Format Journal Article
LanguageEnglish
Published Hagerstown, MD Lippincott Williams & Wilkins 01.04.2022
Wolters Kluwer
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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.
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
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  organization: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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  givenname: Antonio
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  organization: Department of Biostatistics, University of Washington, Seattle, WA
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  organization: Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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  givenname: Frida
  surname: Ayala-Aguillón
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  organization: Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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  givenname: Fernando
  surname: Gil- López
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  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
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– sequence: 7
  givenname: Juan José
  surname: Rodríguez-Crespo
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  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
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  organization: Escuela de Medicina y Ciencias de la Salud TecSalud del Tecnológico de Monterrey, Monterrey, Mexico
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  givenname: Robert C.
  surname: Hyzy
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  organization: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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  givenname: David
  surname: Kershenobich
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  organization: Escuela de Medicina y Ciencias de la Salud TecSalud del Tecnológico de Monterrey, Monterrey, Mexico
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  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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– notice: Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. 2022
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Issue 4
Keywords COVID-19
acute respiratory distress syndrome
mortality
intensive care unit
mechanical ventilation
acute lung injury
Language English
License http://creativecommons.org/licenses/by-nc-nd/4.0
Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.
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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
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Snippet IMPORTANCE: 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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