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 Χ 103 per mm3; IQR, 0.58–1.00 Χ 103 per mm3), 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 mg/m; IQR, 5.0–23.8 mg/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 cmH2 O (IQR, 10–14 cmH2 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 (Pao2 ) to fraction of inspired oxygen (Fio2 ) 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.
Zangrillo, A., Beretta, L., Scandroglio, A.M., Monti, G., Fominskiy, E., Colombo, S., et al. (2020). Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy. CRITICAL CARE AND RESUSCITATION, 22(3), 200-211.
Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy
Monaco F.;
2020
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 Χ 103 per mm3; IQR, 0.58–1.00 Χ 103 per mm3), 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 mg/m; IQR, 5.0–23.8 mg/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 cmH2 O (IQR, 10–14 cmH2 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 (Pao2 ) to fraction of inspired oxygen (Fio2 ) 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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
