Comparison of clinical course and outcomes of critically ill patients with SARS-CoV2 infection managed in traditional ICU and "Flex" ICU during the surge of the pandemic in the Bronx.

BACKGROUNDAs part of the response to increase critical care capacity during the unprecedented surge of COVID-19 infections, NYC Health + Hospital systems identified and resourced areas in the hospital that could deliver critical care as "Flex" ICUs to complement the traditional ICUs to manage the rapid influx of critically ill patients. OBJECTIVEComparison of clinical features and outcomes of mechanically ventilated COVID-19 patients admitted to the traditional and "Flex" ICUs during the surge of the pandemic METHODSRetrospective comparative cohort study of patients with confirmed SARS-CoV-2 infection on mechanical ventilation admitted to traditional ICU and Flex ICU. Univariate and multivariate analysis to detect factors associated with death from COVID-19 patients in mechanical ventilation were performed with the Cox proportional hazards regression model RESULTSOut of the 312 patients on mechanical ventilation, 111 were admitted to the traditional ICU and 201 to the Flex ICU. The mortality rate was higher in the Flex ICU compared with the traditional ICU, but the adjusted risk model was not significantly associated with increased mortality CONCLUSION"Flex" ICUs played a crucial role in the management of critically ill patients during the pandemic. Mortality risk of patients in the "Flex" ICUs were comparable to traditional ICUs in the adjusted analysis. While there is enough evidence for Intensivist managed ICUs to have better outcomes, our study demonstrates the feasibility of non-intensivist led Flex" ICUs during a crisis.