tetano
Editor, Senior Moderator
Can J Anaesth
. 2020 Sep 15.
doi: 10.1007/s12630-020-01816-z. Online ahead of print.
Early experience with critically ill patients with COVID-19 in Montreal
Yiorgos Alexandros Cavayas[SUP] 1 2 [/SUP], Alexandre No?l[SUP] 3 [/SUP], Veronique Brunette[SUP] 3 [/SUP], David Williamson[SUP] 4 5 [/SUP], Anne Julie Frenette[SUP] 5 [/SUP], Christine Arsenault[SUP] 6 [/SUP], Patrick Bellemare[SUP] 3 [/SUP], Colin Lagrenade-Verdant[SUP] 3 [/SUP], Soazig LeGuillan[SUP] 3 7 [/SUP], Emilie Levesque[SUP] 3 [/SUP], Yoan Lamarche[SUP] 3 [/SUP], Marc Giasson[SUP] 3 [/SUP], Philippe Rico[SUP] 3 [/SUP], Yanick Beaulieu[SUP] 3 [/SUP], Pierre Marsolais[SUP] 3 [/SUP], Karim Serri[SUP] 3 4 [/SUP], Francis Bernard[SUP] 3 4 [/SUP], Martin Albert[SUP] 3 4 [/SUP]
Affiliations
Abstract
Purpose: Montreal has been the epicentre of the coronavirus disease (COVID-19) pandemic in Canada. Given the regional disparities in incidence and mortality in the general population, we aimed to describe local characteristics, treatments, and outcomes of critically ill COVID-19 patients in Montreal.
Methods: A single-centre retrospective cohort of consecutive adult patients admitted to the intensive care unit (ICU) of H?pital du Sacr?-Coeur de Montr?al with confirmed COVID-19 were included.
Results: Between 20 March and 13 May 2020, 75 patients were admitted, with a median [interquartile range (IQR)] age of 62 [53-72] yr and high rates of obesity (47%), hypertension (67%), and diabetes (37%). Healthcare-related infections were responsible for 35% of cases. The median [IQR] day 1 sequential organ failure assessment score was 6 [3-7]. Invasive mechanical ventilation (IMV) was used in 57% of patients for a median [IQR] of 11 [5-22] days. Patients receiving IMV were characterized by a moderately decreased median [IQR] partial pressure of oxygen:fraction of inspired oxygen (day 1 PaO[SUB]2[/SUB]:F[SUB]i[/SUB]O[SUB]2[/SUB] = 177 [138-276]; day 10 = 173 [147-227]) and compliance (day 1 = 48 [38-58] mL/cmH[SUB]2[/SUB]O; day 10 = 34 [28-42] mL/cmH[SUB]2[/SUB]O) and very elevated estimated dead space fraction (day 1 = 0.60 [0.53-0.67]; day 10 = 0.72 [0.69-0.79]). Overall hospital mortality was 25%, and 21% in the IMV patients. Mortality was 82% in patients ≥ 80 yr old.
Conclusions: Characteristics and outcomes of critically ill patients with COVID-19 in Montreal were similar to those reported in the existing literature. We found an increased physiologic dead space, supporting the hypothesis that pulmonary vascular injury may be central to COVID-19-induced lung damage.
Keywords: COVID-19; acute respiratory distress syndrome; intensive care; mechanical ventilation.
. 2020 Sep 15.
doi: 10.1007/s12630-020-01816-z. Online ahead of print.
Early experience with critically ill patients with COVID-19 in Montreal
Yiorgos Alexandros Cavayas[SUP] 1 2 [/SUP], Alexandre No?l[SUP] 3 [/SUP], Veronique Brunette[SUP] 3 [/SUP], David Williamson[SUP] 4 5 [/SUP], Anne Julie Frenette[SUP] 5 [/SUP], Christine Arsenault[SUP] 6 [/SUP], Patrick Bellemare[SUP] 3 [/SUP], Colin Lagrenade-Verdant[SUP] 3 [/SUP], Soazig LeGuillan[SUP] 3 7 [/SUP], Emilie Levesque[SUP] 3 [/SUP], Yoan Lamarche[SUP] 3 [/SUP], Marc Giasson[SUP] 3 [/SUP], Philippe Rico[SUP] 3 [/SUP], Yanick Beaulieu[SUP] 3 [/SUP], Pierre Marsolais[SUP] 3 [/SUP], Karim Serri[SUP] 3 4 [/SUP], Francis Bernard[SUP] 3 4 [/SUP], Martin Albert[SUP] 3 4 [/SUP]
Affiliations
- PMID: 32935329
- DOI: 10.1007/s12630-020-01816-z
Abstract
Purpose: Montreal has been the epicentre of the coronavirus disease (COVID-19) pandemic in Canada. Given the regional disparities in incidence and mortality in the general population, we aimed to describe local characteristics, treatments, and outcomes of critically ill COVID-19 patients in Montreal.
Methods: A single-centre retrospective cohort of consecutive adult patients admitted to the intensive care unit (ICU) of H?pital du Sacr?-Coeur de Montr?al with confirmed COVID-19 were included.
Results: Between 20 March and 13 May 2020, 75 patients were admitted, with a median [interquartile range (IQR)] age of 62 [53-72] yr and high rates of obesity (47%), hypertension (67%), and diabetes (37%). Healthcare-related infections were responsible for 35% of cases. The median [IQR] day 1 sequential organ failure assessment score was 6 [3-7]. Invasive mechanical ventilation (IMV) was used in 57% of patients for a median [IQR] of 11 [5-22] days. Patients receiving IMV were characterized by a moderately decreased median [IQR] partial pressure of oxygen:fraction of inspired oxygen (day 1 PaO[SUB]2[/SUB]:F[SUB]i[/SUB]O[SUB]2[/SUB] = 177 [138-276]; day 10 = 173 [147-227]) and compliance (day 1 = 48 [38-58] mL/cmH[SUB]2[/SUB]O; day 10 = 34 [28-42] mL/cmH[SUB]2[/SUB]O) and very elevated estimated dead space fraction (day 1 = 0.60 [0.53-0.67]; day 10 = 0.72 [0.69-0.79]). Overall hospital mortality was 25%, and 21% in the IMV patients. Mortality was 82% in patients ≥ 80 yr old.
Conclusions: Characteristics and outcomes of critically ill patients with COVID-19 in Montreal were similar to those reported in the existing literature. We found an increased physiologic dead space, supporting the hypothesis that pulmonary vascular injury may be central to COVID-19-induced lung damage.
Keywords: COVID-19; acute respiratory distress syndrome; intensive care; mechanical ventilation.