tetano
Editor, Senior Moderator
Crit Care Resusc
. 2020 Sep;22(3):200-211.
Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy
Alberto Zangrillo[SUP] 1 [/SUP], Luigi Beretta[SUP] 1 [/SUP], Anna Mara Scandroglio[SUP] 1 [/SUP], Giacomo Monti[SUP] 1 [/SUP], Evgeny Fominskiy[SUP] 1 [/SUP], Sergio Colombo[SUP] 1 [/SUP], Federica Morselli[SUP] 1 [/SUP], Alessandro Belletti[SUP] 1 [/SUP], Paolo Silvani[SUP] 1 [/SUP], Martina Crivellari[SUP] 1 [/SUP], Fabrizio Monaco[SUP] 1 [/SUP], Maria Luisa Azzolini[SUP] 1 [/SUP], Raffaella Reineke[SUP] 1 [/SUP], Pasquale Nardelli[SUP] 1 [/SUP], Marianna Sartorelli[SUP] 1 [/SUP], Carmine D Votta[SUP] 1 [/SUP], Annalisa Ruggeri[SUP] 1 [/SUP], Fabio Ciceri[SUP] 2 [/SUP], Francesco De Cobelli[SUP] 2 [/SUP], Moreno Tresoldi[SUP] 3 [/SUP], Lorenzo Dagna[SUP] 2 [/SUP], Patrizia Rovere-Querini[SUP] 2 [/SUP], Ary Serpa Neto[SUP] 4 [/SUP], Rinaldo Bellomo[SUP] 4 [/SUP], Giovanni Landoni[SUP] 5 [/SUP], COVID-BioB Study Group
Affiliations
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.
. 2020 Sep;22(3):200-211.
Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy
Alberto Zangrillo[SUP] 1 [/SUP], Luigi Beretta[SUP] 1 [/SUP], Anna Mara Scandroglio[SUP] 1 [/SUP], Giacomo Monti[SUP] 1 [/SUP], Evgeny Fominskiy[SUP] 1 [/SUP], Sergio Colombo[SUP] 1 [/SUP], Federica Morselli[SUP] 1 [/SUP], Alessandro Belletti[SUP] 1 [/SUP], Paolo Silvani[SUP] 1 [/SUP], Martina Crivellari[SUP] 1 [/SUP], Fabrizio Monaco[SUP] 1 [/SUP], Maria Luisa Azzolini[SUP] 1 [/SUP], Raffaella Reineke[SUP] 1 [/SUP], Pasquale Nardelli[SUP] 1 [/SUP], Marianna Sartorelli[SUP] 1 [/SUP], Carmine D Votta[SUP] 1 [/SUP], Annalisa Ruggeri[SUP] 1 [/SUP], Fabio Ciceri[SUP] 2 [/SUP], Francesco De Cobelli[SUP] 2 [/SUP], Moreno Tresoldi[SUP] 3 [/SUP], Lorenzo Dagna[SUP] 2 [/SUP], Patrizia Rovere-Querini[SUP] 2 [/SUP], Ary Serpa Neto[SUP] 4 [/SUP], Rinaldo Bellomo[SUP] 4 [/SUP], Giovanni Landoni[SUP] 5 [/SUP], COVID-BioB Study Group
Affiliations
- PMID: 32900326
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.