Related Experiment Video

Updated: Aug 26, 2025

Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device

Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device

Published on: September 24, 2020

Changing Critical Care Patterns and Associated Outcomes in Mechanically Ventilated Severe COVID-19 Patients in

Saurabh Saigal¹, Ankur Joshi², Rajesh Panda¹

¹Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine

|October 10, 2022

Insights

Outcomes for mechanically ventilated COVID-19 ARDS patients varied over time. Shorter symptom-to-intubation times and higher driving pressures increased mortality risk in this critical illness study.

Area of Science:

Critical Care Medicine
Pulmonology
Infectious Diseases

Background:

Investigates factors influencing outcomes in mechanically ventilated COVID-19 ARDS patients in Central India.
Analyzes outcomes across four distinct time periods during the pandemic.
Represents one of the largest global series of such patients.

Purpose of the Study:

To identify predictors of mortality in mechanically ventilated COVID-19 ARDS patients.
To assess how outcomes and influencing factors changed over different pandemic time periods.
To evaluate the impact of critical care parameters on patient survival.

Main Methods:

Retrospective cohort study of 288 mechanically ventilated COVID-19 ARDS patients.
Data divided into four time periods from April 2020 to April 2021.
Multivariable-adjusted analysis using mixed-effect binomial logistic regression.

Main Results:

Survival proportion increased across the four time periods (0% to 28.6%).
Symptom-intubation interval (OR 1.16) and driving pressures (OR 1.17) were significant predictors of mortality.
High steroid use showed a protective effect (OR 0.59).

Conclusions:

Outcomes for mechanically ventilated COVID-19 ARDS patients are heterogeneous and vary over time.
Patient outcomes are influenced by a complex interplay of baseline risk and critical care parameters.
Findings highlight the dynamic nature of critical care in severe COVID-19.

Read full analysis

Abstract

Background:

The outcomes in critical illness depend on disease severity, practice protocols, workload, and access to care. This study investigates the factors affecting outcomes in mechanically ventilated coronavirus disease-2019 acute respiratory distress syndrome (COVID-19 ARDS) patients admitted in a tertiary teaching hospital intensive care unit (ICU) in Central India with reference to different time periods in pandemic. This is one of the largest series of mechanically ventilated COVID-19 ARDS patients, globally.

Methods:

This retrospective cohort study classified the entire data into four time periods (Period 1: April 2020 to June 2020; Period 2: July 2020 to September 2020; Period 3: October 2020 to December 2020; and Period 4: January 2021 to April 2021). We performed a multivariable-adjusted analysis to evaluate predictors of mortality, adjusted for baseline-severity, sequential organ failure assessment (SOFA score) and time period. We applied mixed-effect binomial logistic regression to model fixed-effect variables with incremental complexity.

Results:

Among the 56 survivors (19.4%) out of 288 mechanically ventilated patients, there was an up-gradient of survival proportion (0, 18.2, 17.4, and 28.6%) in four time periods. Symptom-intubation interval (OR 1.16; 95% CI 1.03-1.31) and driving pressures (DPs) (OR 1.17; 95% CI 1.07-1.28) were significant predictors of mortality in the model having minimal AIC and BIC values. Patients aged above 60 years also had a larger effect, but statistically insignificant effect favoring mortality (OR 1.99; 95% CI 0.92-4.27). The most complex but less parsimonious model (with higher AIC/BIC) indicated the protective odds of high steroid on mortality (OR 0.59; 95% CI 0.59-0.82).

Conclusion:

The outcomes in mechanically ventilated COVID-19 ARDS patients are heterogeneous across time windows and may be affected by the complex interaction of baseline risk and critical care parameters.

How To Cite This Article:

Saigal S, Joshi A, Panda R, Goyal A, Kodamanchili S, Anand A, et al. Changing Critical Care Patterns and Associated Outcomes in Mechanically Ventilated Severe COVID-19 Patients in Different Time Periods: An Explanatory Study from Central India. Indian J Crit Care Med 2022;26(9):1022-1030.

Keywords:

Acute respiratory distress syndrome Coronavirus disease-2019 Intensive care unit Mechanical ventilation

More Related Videos

An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient

An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient

Published on: November 30, 2022

Use of a Central Venous Line for Fluids, Drugs and Nutrient Administration in a Mouse Model of Critical Illness

Use of a Central Venous Line for Fluids, Drugs and Nutrient Administration in a Mouse Model of Critical Illness

Published on: May 2, 2017

Related Concept Videos

Mechanical Ventilation I: Indication and Settings

Mechanical Ventilation I: Indication and Settings

Mechanical ventilation is a life-saving technique for managing acute respiratory failure and other respiratory complications. The process involves using a machine known as a ventilator to supply oxygen to the lungs and assist in removing carbon dioxide. It serves as a bridge to long-term mechanical ventilation or a temporary measure until ventilatory support is discontinued. The ventilator can maintain this function for a prolonged period, providing critical support for patients until they can...

Acute Respiratory Failure-II

Acute Respiratory Failure-II

Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:

Acute Respiratory Failure-V

Acute Respiratory Failure-V

The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...

Acute Respiratory Failure-III

Acute Respiratory Failure-III

Hypercapnic respiratory failure, also known as Type 2 or ventilatory respiratory failure, is a severe condition characterized by the body's inability to effectively remove carbon dioxide (CO2) from the bloodstream. It leads to an arterial CO2 pressure (PaCO2) exceeding 45 mmHg and a blood pH above 7.35. This situation indicates that the body's ventilatory demand, or the ventilation needed to maintain normal PaCO2 levels, surpasses its supply or the maximum gas flow achievable without...

Mechanical Ventilation II: Invasive Ventilation

Mechanical Ventilation II: Invasive Ventilation

Ventilators are essential medical equipment used to aid patients with respiratory difficulties. Their primary function is to assist or replace spontaneous breathing by providing mechanical ventilation. There are two general classes of mechanical ventilators: negative-pressure and positive-pressure ventilators.
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...

Acute Respiratory Failure-I

Acute Respiratory Failure-I

Acute respiratory failure is a condition characterized by the inability of the lungs to perform their primary function: gas exchange. This failure leads to insufficient oxygen levels (hypoxemia) in the blood, elevated carbon dioxide levels (hypercapnia), or both, causing critical impairment in organ function.
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...

Articles linked to this work by shared authors, journal, and citation graph.

Symptomatic Sclerosing Pneumocytoma of Lung: A Diagnostic Challenge with Diverse Morphological Patterns.

Iranian journal of pathology·2026

Rapid Detection of Resistance Mutations in Multidrug-Resistant Tuberculosis With GenoType MTBDRsl Assay.

Pulmonary medicine·2026

Viscoelastic Hemostatic Assays in Spine Surgery: A Scoping Review of Perioperative Transfusion Practices and Coagulation Assessment.

Journal of neurosurgical anesthesiology·2026

Correspondence Regarding: "A Prospective Comparative Study of Optic Nerve Sheath Diameter Measurement by Ultrasonography vs Computed Tomography Scan for the Detection of Elevated Intracranial Pressure in Patients with Acute Neurological Emergencies".

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine·2026

Sleep related rhythmic movement disorder treated with positive airway pressure.

Sleep and biological rhythms·2026

Coverage, delivery models, and implementation challenges of the community driven nutritional supplementation initiative for people with TB: A mixed methods study from Puducherry, India.

PLOS global public health·2025

See all related articles