covid: 33% Covid fatality rate in govt ICUs better than global average | Bengaluru News – Times of India


BENGALURU: The fatality rate in Covid ICUs of government hospitals was 32.8% during the pandemic, according to data with the state health and family welfare department. Officials said the global average is 42%-62%.
The Karnataka government, through its critical-care support team and experts from private hospitals, had facilitated tele-ICU facility at ICUs in government hospitals across the state to remotely monitor and guide the doctors.
“The case fatality rate (CFR) in Covid ICUs is much lower in government hospitals where the tele-ICU intervention was made. It’s lower than the global average of 42% to 62%,” said KV Trilok Chandra, nodal officer, Critical Care Support System Team (CCST) for Covid.
The state government recently presented its tele-ICU intervention before the Union health ministry.
Fatality rate doesn’t reflect ICU performance: Doctor
Till September 2021, there were total 46,583 patients admitted to government hospitals catered by tele-ICU. Of them 15,275 patients died and the ICU case fatality rate was 32.7%, Chandra explained. As per the studies published by the Association of Anaesthetists, a global forum, in February 2021, Covid-19 ICU fatality rates have varied from 16.7% to 70% in different parts of the world at different intervals.CCST was started in April 2020 and its doctors conducted tele-ICU rounds with district hospitals to standardise treatment at all ICUs. “Compared to the global data, it is an acceptable rate,” said Dr Pradeep Rangappa, a member of CCST. He highlighted that a Turkey study showed 62.8% mortality rate, and in China it was 25.7% to 37.7%.
According to Dr Rajesh Shetty, executive committee member of Indian Society of Critical Care Medicine, Bengaluru chapter, to understand the ICU mortality rate, the group of patients has to be identified whether they were on ventilator, non-invasive ventilator, on high-flow nasal oxygen support, based on severity.
“The ICU fatality rate depends on the type of patients admitted to ICU. Some ICUs admit only patients requiring non-invasive ventilator, ventilator or ECMO. The mortality rate is very difficult to compare,” he said.
However, no patient was on ECMO therapy, which replaces the function of the lungs and the heart.
The Covid ICU mortality rate in corporate hospitals in Bengaluru that extensively treated critical cases requiring ventilators was 20-25 %, said a senior doctor from the city.
Doctors TOI spoke with said that there are variables — the two different waves of Covid, the patient condition at admission, age and comorbidities and treatment given — to be considered to understand the ICU mortality rate. “All these factors skew the mortality rate. In some hospitals, it was higher during the first wave. In the second wave, the sheer increase in the number of persons requiring ventilators amid the shortage worsened the situation,” said a doctor.
Besides, admission criteria to the ICU and the cause of death and definition of mortality vary from one country to another, said doctors.
Another top specialist mentioned that the Covid fatality rate in the ICUs does not reflect the performance of an ICU. “What needs to be calculated is the Standardised Mortality Rate (SMR), which is the indicator of the critical-care quality. It gives us a comparison of the actual hospital mortality of all the patients in the ICU with predicted mortality. If the SMR is less than 1, it means that the ICU has performed well in saving lives. SMR is the globally accepted parameter,” the doctor said.
If SMR is more than 1, it means that the patient could have possibly survived but for some reason s/he has died and the ICU performance has to improve. The SMR scoring is done based on Acute Physiologic Assessment and Chronic Health Evaluation (Apache). Apache scoring depends on variables, including the age and comorbidities. It answers the question was the patient sick enough to die, said doctors.
Sources said district hospitals were working on finding their Apache scores. “During tele-ICU rounds, the common narrative was patients arrived with delayed presentation, late referrals,” sources said.
However, the SMR scores of government hospitals and the district-wise ICU mortality rates could not be accessed.
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Sagar Biswas

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