tetano
Editor, Senior Moderator
Aust Crit Care
. 2020 Oct 27;S1036-7314(20)30334-9.
doi: 10.1016/j.aucc.2020.10.009. Online ahead of print.
Mechanical ventilation and mortality among 223 critically ill patients with coronavirus disease 2019: A multicentric study in Germany
Kevin Roedl[SUP] 1 [/SUP], Dominik Jarczak[SUP] 2 [/SUP], Liina Thasler[SUP] 2 [/SUP], Martin Bachmann[SUP] 3 [/SUP], Frank Schulte[SUP] 4 [/SUP], Berthold Bein[SUP] 5 [/SUP], Christian Friedrich Weber[SUP] 6 [/SUP], Ulrich Sch?fer[SUP] 7 [/SUP], Carsten Veit[SUP] 8 [/SUP], Hans-Peter Hauber[SUP] 9 [/SUP], Sebastian Kopp[SUP] 10 [/SUP], Karsten Sydow[SUP] 11 [/SUP], Andreas de Weerth[SUP] 12 [/SUP], Marc Bota[SUP] 13 [/SUP], R?diger Schreiber[SUP] 14 [/SUP], Oliver Detsch[SUP] 15 [/SUP], Jan-Peer Rogmann[SUP] 16 [/SUP], Daniel Frings[SUP] 2 [/SUP], Barbara Sensen[SUP] 2 [/SUP], Christoph Burdelski[SUP] 2 [/SUP], Olaf Boenisch[SUP] 2 [/SUP], Axel Nierhaus[SUP] 2 [/SUP], Geraldine de Heer[SUP] 2 [/SUP], Stefan Kluge[SUP] 2 [/SUP]
Affiliations
Abstract
Background: There are large uncertainties with regard to the outcome of patients with coronavirus disease 2019 (COVID-19) and mechanical ventilation (MV). High mortality (50-97%) was proposed by some groups, leading to considerable uncertainties with regard to outcomes of critically ill patients with COVID-19.
Objectives: The aim was to investigate the characteristics and outcomes of critically ill patients with COVID-19 requiring intensive care unit (ICU) admission and MV.
Methods: A multicentre retrospective observational cohort study at 15 hospitals in Hamburg, Germany, was performed. Critically ill adult patients with COVID-19 who completed their ICU stay between February and June 2020 were included. Patient demographics, severity of illness, and ICU course were retrospectively evaluated.
Results: A total of 223 critically ill patients with COVID-19 were included. The majority, 73% (n = 163), were men; the median age was 69 (interquartile range = 58-77.5) years, with 68% (n = 151) patients having at least one chronic medical condition. Their Sequential Organ Failure Assessment score was a median of 5 (3-9) points on admission. Overall, 167 (75%) patients needed MV. Noninvasive ventilation and high-flow nasal cannula were used in 31 (14%) and 26 (12%) patients, respectively. Subsequent MV, due to noninvasive ventilation/high-flow nasal cannula therapy failure, was necessary in 46 (81%) patients. Renal replacement therapy was initiated in 33% (n = 72) of patients, and owing to severe respiratory failure, extracorporeal membrane oxygenation was necessary in 9% (n = 20) of patients. Experimental antiviral therapy was used in 9% (n = 21) of patients. Complications during the ICU stay were as follows: septic shock (40%, n = 90), heart failure (8%, n = 17), and pulmonary embolism (6%, n = 14). The length of ICU stay was a median of 13 days (5-24), and the duration of MV was 15 days (8-25). The ICU mortality was 35% (n = 78) and 44% (n = 74) among mechanically ventilated patients.
Conclusion: In this multicentre observational study of 223 critically ill patients with COVID-19, the survival to ICU discharge was 65%, and it was 56% among patients requiring MV. Patients showed high rate of septic complications during their ICU stay.
Keywords: ARDS; COVID-19; Mechanical ventilation; Mortality; Multiple organ failure; SARS-CoV-2.
. 2020 Oct 27;S1036-7314(20)30334-9.
doi: 10.1016/j.aucc.2020.10.009. Online ahead of print.
Mechanical ventilation and mortality among 223 critically ill patients with coronavirus disease 2019: A multicentric study in Germany
Kevin Roedl[SUP] 1 [/SUP], Dominik Jarczak[SUP] 2 [/SUP], Liina Thasler[SUP] 2 [/SUP], Martin Bachmann[SUP] 3 [/SUP], Frank Schulte[SUP] 4 [/SUP], Berthold Bein[SUP] 5 [/SUP], Christian Friedrich Weber[SUP] 6 [/SUP], Ulrich Sch?fer[SUP] 7 [/SUP], Carsten Veit[SUP] 8 [/SUP], Hans-Peter Hauber[SUP] 9 [/SUP], Sebastian Kopp[SUP] 10 [/SUP], Karsten Sydow[SUP] 11 [/SUP], Andreas de Weerth[SUP] 12 [/SUP], Marc Bota[SUP] 13 [/SUP], R?diger Schreiber[SUP] 14 [/SUP], Oliver Detsch[SUP] 15 [/SUP], Jan-Peer Rogmann[SUP] 16 [/SUP], Daniel Frings[SUP] 2 [/SUP], Barbara Sensen[SUP] 2 [/SUP], Christoph Burdelski[SUP] 2 [/SUP], Olaf Boenisch[SUP] 2 [/SUP], Axel Nierhaus[SUP] 2 [/SUP], Geraldine de Heer[SUP] 2 [/SUP], Stefan Kluge[SUP] 2 [/SUP]
Affiliations
- PMID: 33250401
- DOI: 10.1016/j.aucc.2020.10.009
Abstract
Background: There are large uncertainties with regard to the outcome of patients with coronavirus disease 2019 (COVID-19) and mechanical ventilation (MV). High mortality (50-97%) was proposed by some groups, leading to considerable uncertainties with regard to outcomes of critically ill patients with COVID-19.
Objectives: The aim was to investigate the characteristics and outcomes of critically ill patients with COVID-19 requiring intensive care unit (ICU) admission and MV.
Methods: A multicentre retrospective observational cohort study at 15 hospitals in Hamburg, Germany, was performed. Critically ill adult patients with COVID-19 who completed their ICU stay between February and June 2020 were included. Patient demographics, severity of illness, and ICU course were retrospectively evaluated.
Results: A total of 223 critically ill patients with COVID-19 were included. The majority, 73% (n = 163), were men; the median age was 69 (interquartile range = 58-77.5) years, with 68% (n = 151) patients having at least one chronic medical condition. Their Sequential Organ Failure Assessment score was a median of 5 (3-9) points on admission. Overall, 167 (75%) patients needed MV. Noninvasive ventilation and high-flow nasal cannula were used in 31 (14%) and 26 (12%) patients, respectively. Subsequent MV, due to noninvasive ventilation/high-flow nasal cannula therapy failure, was necessary in 46 (81%) patients. Renal replacement therapy was initiated in 33% (n = 72) of patients, and owing to severe respiratory failure, extracorporeal membrane oxygenation was necessary in 9% (n = 20) of patients. Experimental antiviral therapy was used in 9% (n = 21) of patients. Complications during the ICU stay were as follows: septic shock (40%, n = 90), heart failure (8%, n = 17), and pulmonary embolism (6%, n = 14). The length of ICU stay was a median of 13 days (5-24), and the duration of MV was 15 days (8-25). The ICU mortality was 35% (n = 78) and 44% (n = 74) among mechanically ventilated patients.
Conclusion: In this multicentre observational study of 223 critically ill patients with COVID-19, the survival to ICU discharge was 65%, and it was 56% among patients requiring MV. Patients showed high rate of septic complications during their ICU stay.
Keywords: ARDS; COVID-19; Mechanical ventilation; Mortality; Multiple organ failure; SARS-CoV-2.