April 8, 2020

expert comment on ICU recovery data on COVID-19

There have been questions from journalists on the illness and treatment progression for patients in ICU.

Prof Duncan Young, Professor of Intensive Care Medicine, University of Oxford, said:

“No-one knows how long it takes to fully recover from COVID-19 infections because as yet it has not been studied.

“The ICNARC report^± suggests the median (commonest) duration of an ICU admission in patients with COVID-19 infections who survive is 4 days, but a quarter stay 8 or more days. The report from Lombardy in JAMA^¥ gives the commonest ICU stay for survivors as 8 days, a quarter stayed 12 or more days. The difference may be due to relatively small numbers of patients, different ICU admission or discharge criteria, or different patient characteristics.

“ICNARC do collect the duration of hospital stay but as many COVID patients are still in hospital they have not reported this.

“In the UK the average hospital ward stay after a patient is discharged from an ICU (not COVID-19 related) is about 15 days but there is a very wide range and a quarter stay 48 days or more in the hospital after ICU discharge (https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports/Summary-Statistics).

“In general the time in hospital depends on what co-morbidities a patient has, what the acute illness is that required ICU treatment, and the duration and intensity of ICU treatment.

“If a patient requires a ventilator and is not put on one their chances of survival are virtually nil. Data from the last ICNARC report indicated that of patients who have left ICU about two thirds of patients who received artificial ventilation for COVID-19 infection died. In the less severely ill patients admitted to an ICU but not requiring artificial ventilation only a sixth died. However there are a lot a patients still in ICUs compared with patients who have left, so these proportions may change as data on the discharge of more patients becomes available.

“Data are available on survival in the last ICNARC report. Of all patients discharged from ICUs in England, Wales and Northern Ireland the proportion of patients who died was slightly higher in men. The proportion who died increases markedly with age from just under a quarter in the 16-49 age bracket, to just under half in the 50-69 age group, to over two thirds in the 70+ age group. There are no data on the longer term effects such as duration of hospital stay after ICU care in the UK or time to full recovery. As before there are a lot a patients still in ICUs compared with patients who have left, so these proportions may change as data on the discharge of more patients becomes available.”

^±https://www.icnarc.org/About/Latest-News/2020/04/04/Report-On-2249-Patients-Critically-Ill-With-Covid-19

^¥https://jamanetwork.com/journals/jama/fullarticle/2764365

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Declared interests

None received.