tetano
Editor, Senior Moderator
Crit Care Resusc. 2020 Apr 23. [Epub ahead of print]
Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy.
Zangrillo A[SUP]1[/SUP], Beretta L[SUP]1[/SUP], Scandroglio AM[SUP]1[/SUP], Monti G[SUP]1[/SUP], Fominskiy E[SUP]1[/SUP], Colombo S[SUP]1[/SUP], Morselli F[SUP]1[/SUP], Belletti A[SUP]1[/SUP], Silvani P[SUP]1[/SUP], Crivellari M[SUP]1[/SUP], Monaco F[SUP]1[/SUP], Azzolini ML[SUP]1[/SUP], Reineke R[SUP]1[/SUP], Nardelli P[SUP]1[/SUP], Sartorelli M[SUP]1[/SUP], Votta CD[SUP]1[/SUP], Ruggeri A[SUP]1[/SUP], Ciceri F[SUP]2[/SUP], De Cobelli F[SUP]2[/SUP], Tresoldi M[SUP]3[/SUP], Dagna L[SUP]2[/SUP], Rovere-Querini P[SUP]2[/SUP], Serpa Neto A[SUP]4[/SUP], Bellomo R[SUP]4[/SUP], Landoni G[SUP]5[/SUP]; COVID-BioB Study Group.
Author information
Abstract
Objective:
Describe characteristics, daily care and outcomes of patients with coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS).
Design:
Case series of 73 patients.
Setting:
Large tertiary hospital in Milan.
Participants:
Mechanically ventilated patients with confirmed COVID-19 admitted to the intensive care unit (ICU) between 20 February and 2 April 2020.
Main outcome measures:
Demographic and daily clinical data were collected to identify predictors of early mortality.
Results:
Of the 73 patients included in the study, most were male (83.6%), the median age was 61 years (interquartile range [IQR], 54-69 years), and hypertension affected 52.9% of patients. Lymphocytopenia (median, 0.77 x 10[SUP]3[/SUP] per mm[SUP]3[/SUP] ; IQR, 0.58-1.00 x 10[SUP]3[/SUP] per mm[SUP]3[/SUP]), hyperinflammation with C-reactive protein (median, 184.5 mg/dL; IQR, 108.2-269.1 mg/dL) and pro-coagulant status with D-dimer (median, 10.1 μg/m; IQR, 5.0-23.8 μg/m) were present. Median tidal volume was 6.7 mL/kg (IQR, 6.0-7.5 mL/kg), and median positive end-expiratory pressure was 12 cmH[SUB]2[/SUB]O (IQR, 10-14 cmH[SUB]2[/SUB]O). In the first 3 days, prone positioning (12-16 h) was used in 63.8% of patients and extracorporeal membrane oxygenation in five patients (6.8%). After a median follow-up of 19.0 days (IQR, 15.0-27.0 days), 17 patients (23.3%) had died, 23 (31.5%) had been discharged from the ICU, and 33 (45.2%) were receiving invasive mechanical ventilation in the ICU. Older age (odds ratio [OR], 1.12; 95% CI, 1.04-1.22; P = 0.004) and hypertension (OR, 6.15; 95% CI, 1.75-29.11; P = 0.009) were associated with mortality, while early improvement in arterial partial pressure of oxygen (PaO[SUB]2[/SUB]) to fraction of inspired oxygen (FiO[SUB]2[/SUB]) ratio was associated with being discharged alive from the ICU (P = 0.002 for interaction).
Conclusions:
Despite multiple advanced critical care interventions, COVID-19 ARDS was associated with prolonged ventilation and high short term mortality. Older age and pre-admission hypertension were key mortality risk factors.
Trial registration:
ClinicalTrials.gov identifier: NCT04318366.
KEYWORDS:
Anesthesia and intensive care; COVID-19; ICU; SARS-CoV-2
PMID:32353223
Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy.
Zangrillo A[SUP]1[/SUP], Beretta L[SUP]1[/SUP], Scandroglio AM[SUP]1[/SUP], Monti G[SUP]1[/SUP], Fominskiy E[SUP]1[/SUP], Colombo S[SUP]1[/SUP], Morselli F[SUP]1[/SUP], Belletti A[SUP]1[/SUP], Silvani P[SUP]1[/SUP], Crivellari M[SUP]1[/SUP], Monaco F[SUP]1[/SUP], Azzolini ML[SUP]1[/SUP], Reineke R[SUP]1[/SUP], Nardelli P[SUP]1[/SUP], Sartorelli M[SUP]1[/SUP], Votta CD[SUP]1[/SUP], Ruggeri A[SUP]1[/SUP], Ciceri F[SUP]2[/SUP], De Cobelli F[SUP]2[/SUP], Tresoldi M[SUP]3[/SUP], Dagna L[SUP]2[/SUP], Rovere-Querini P[SUP]2[/SUP], Serpa Neto A[SUP]4[/SUP], Bellomo R[SUP]4[/SUP], Landoni G[SUP]5[/SUP]; COVID-BioB Study Group.
Author information
Abstract
Objective:
Describe characteristics, daily care and outcomes of patients with coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS).
Design:
Case series of 73 patients.
Setting:
Large tertiary hospital in Milan.
Participants:
Mechanically ventilated patients with confirmed COVID-19 admitted to the intensive care unit (ICU) between 20 February and 2 April 2020.
Main outcome measures:
Demographic and daily clinical data were collected to identify predictors of early mortality.
Results:
Of the 73 patients included in the study, most were male (83.6%), the median age was 61 years (interquartile range [IQR], 54-69 years), and hypertension affected 52.9% of patients. Lymphocytopenia (median, 0.77 x 10[SUP]3[/SUP] per mm[SUP]3[/SUP] ; IQR, 0.58-1.00 x 10[SUP]3[/SUP] per mm[SUP]3[/SUP]), hyperinflammation with C-reactive protein (median, 184.5 mg/dL; IQR, 108.2-269.1 mg/dL) and pro-coagulant status with D-dimer (median, 10.1 μg/m; IQR, 5.0-23.8 μg/m) were present. Median tidal volume was 6.7 mL/kg (IQR, 6.0-7.5 mL/kg), and median positive end-expiratory pressure was 12 cmH[SUB]2[/SUB]O (IQR, 10-14 cmH[SUB]2[/SUB]O). In the first 3 days, prone positioning (12-16 h) was used in 63.8% of patients and extracorporeal membrane oxygenation in five patients (6.8%). After a median follow-up of 19.0 days (IQR, 15.0-27.0 days), 17 patients (23.3%) had died, 23 (31.5%) had been discharged from the ICU, and 33 (45.2%) were receiving invasive mechanical ventilation in the ICU. Older age (odds ratio [OR], 1.12; 95% CI, 1.04-1.22; P = 0.004) and hypertension (OR, 6.15; 95% CI, 1.75-29.11; P = 0.009) were associated with mortality, while early improvement in arterial partial pressure of oxygen (PaO[SUB]2[/SUB]) to fraction of inspired oxygen (FiO[SUB]2[/SUB]) ratio was associated with being discharged alive from the ICU (P = 0.002 for interaction).
Conclusions:
Despite multiple advanced critical care interventions, COVID-19 ARDS was associated with prolonged ventilation and high short term mortality. Older age and pre-admission hypertension were key mortality risk factors.
Trial registration:
ClinicalTrials.gov identifier: NCT04318366.
KEYWORDS:
Anesthesia and intensive care; COVID-19; ICU; SARS-CoV-2
PMID:32353223