Evaluating the Effects of the COVID-19 Pandemic on ICU Mortality and Sedation Charges in Mechanically Ventilated Patients
Author(s)
Caroline Paley, PharmD1, Ryan Rivosecchi, PharmD2, Kangho Suh, PharmD, PhD1;
1University of Pittsburgh School of Pharmacy, Pharmacy and Therapeutics, Pittsburgh, PA, USA, 2UPMC Presbyterian Hospital, Pharmacy, Pittsburgh, PA, USA
1University of Pittsburgh School of Pharmacy, Pharmacy and Therapeutics, Pittsburgh, PA, USA, 2UPMC Presbyterian Hospital, Pharmacy, Pittsburgh, PA, USA
Presentation Documents
OBJECTIVES: The COVID-19 pandemic fundamentally challenged healthcare infrastructure and delivery, particularly during its peak periods. The extent to which these disruptions affected the clinical care and outcomes of patients without COVID-19 in intensive care units during the pandemic remains unclear. This study aimed to compare the sedative drug charges and mortality of mechanically ventilated (MV) intensive care unit (ICU) patients without COVID-19 during various periods of COVID-19 admissions.
METHODS: Clinical data for ICU patients admitted within the University of Pittsburgh Medical Center system from March 2020 through December 2022 were included in the study. High and low periods of COVID-19 were defined as months when MV ICU patients with COVID-19 comprised 50% or more of all MV ICU patients. Charges for sedation drugs were calculated based on the 2023 UPMC chargemaster for individual agents (dexmedetomidine, ketamine, fentanyl, propofol, midazolam). A mixed-effects logistic regression was used to evaluate the association between COVID-19 periods and ICU mortality. Random intercepts at the hospital and patient level accounted for the hierarchical data structure. A two-part model was used to assess charges. Both models were adjusted for demographic, clinical, and ICU characteristics.
RESULTS: Periods of high COVID-19 were associated with 13.7% increased odds of ICU mortality in MV patients without COVID-19. Significant covariates associated with increased odds of ICU mortality included higher age and Global Open Source Severity of Illness Score. There was no significant difference in charges between COVID-19 periods.
CONCLUSIONS: High COVID-19 periods were associated with increased odds of ICU mortality among non-COVID-19 patients, emphasizing the indirect impact of the pandemic on ICU outcomes. The lack of significant differences in sedation drug charges suggests consistent resource allocation across periods. Future research should explore how ICU and patient characteristics influence mortality and sedation practices to identify targeted strategies for improving outcomes during healthcare crises.
METHODS: Clinical data for ICU patients admitted within the University of Pittsburgh Medical Center system from March 2020 through December 2022 were included in the study. High and low periods of COVID-19 were defined as months when MV ICU patients with COVID-19 comprised 50% or more of all MV ICU patients. Charges for sedation drugs were calculated based on the 2023 UPMC chargemaster for individual agents (dexmedetomidine, ketamine, fentanyl, propofol, midazolam). A mixed-effects logistic regression was used to evaluate the association between COVID-19 periods and ICU mortality. Random intercepts at the hospital and patient level accounted for the hierarchical data structure. A two-part model was used to assess charges. Both models were adjusted for demographic, clinical, and ICU characteristics.
RESULTS: Periods of high COVID-19 were associated with 13.7% increased odds of ICU mortality in MV patients without COVID-19. Significant covariates associated with increased odds of ICU mortality included higher age and Global Open Source Severity of Illness Score. There was no significant difference in charges between COVID-19 periods.
CONCLUSIONS: High COVID-19 periods were associated with increased odds of ICU mortality among non-COVID-19 patients, emphasizing the indirect impact of the pandemic on ICU outcomes. The lack of significant differences in sedation drug charges suggests consistent resource allocation across periods. Future research should explore how ICU and patient characteristics influence mortality and sedation practices to identify targeted strategies for improving outcomes during healthcare crises.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO8
Topic
Clinical Outcomes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas