Baseline characteristics and outcomes of patients with COVID-19 admitted to intensive care units in Vancouver, Canada: a case series.


Journal

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
ISSN: 1488-2329
Titre abrégé: CMAJ
Pays: Canada
ID NLM: 9711805

Informations de publication

Date de publication:
29 06 2020
Historique:
accepted: 12 05 2020
pubmed: 29 5 2020
medline: 14 7 2020
entrez: 29 5 2020
Statut: ppublish

Résumé

Pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with high intensive care unit (ICU) mortality. We aimed to describe the clinical characteristics and outcomes of critically ill patients with coronavirus disease 2019 (COVID-19) in a Canadian setting. We conducted a retrospective case series of critically ill patients with laboratory-confirmed SARS-CoV-2 infection consecutively admitted to 1 of 6 ICUs in Metro Vancouver, British Columbia, Canada, between Feb. 21 and Apr. 14, 2020. Demographic, management and outcome data were collected by review of patient charts and electronic medical records. Between Feb. 21 and Apr. 14, 2020, 117 patients were admitted to the ICU with a confirmed diagnosis of COVID-19. The median age was 69 (interquartile range [IQR] 60-75) years, and 38 (32.5%) were female. At least 1 comorbidity was present in 86 (73.5%) patients. Invasive mechanical ventilation was required in 74 (63.2%) patients. The duration of mechanical ventilation was 13.5 (IQR 8-22) days overall and 11 (IQR 6-16) days for patients successfully discharged from the ICU. Tocilizumab was administered to 4 patients and hydroxychloroquine to 1 patient. As of May 5, 2020, a total of 18 (15.4%) patients had died, 12 (10.3%) remained in the ICU, 16 (13.7%) were discharged from the ICU but remained in hospital, and 71 (60.7%) were discharged home. In our setting, mortality in critically ill patients with COVID-19 admitted to the ICU was lower than in previously published studies. These data suggest that the prognosis associated with critical illness due to COVID-19 may not be as poor as previously reported.

Sections du résumé

BACKGROUND
Pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with high intensive care unit (ICU) mortality. We aimed to describe the clinical characteristics and outcomes of critically ill patients with coronavirus disease 2019 (COVID-19) in a Canadian setting.
METHODS
We conducted a retrospective case series of critically ill patients with laboratory-confirmed SARS-CoV-2 infection consecutively admitted to 1 of 6 ICUs in Metro Vancouver, British Columbia, Canada, between Feb. 21 and Apr. 14, 2020. Demographic, management and outcome data were collected by review of patient charts and electronic medical records.
RESULTS
Between Feb. 21 and Apr. 14, 2020, 117 patients were admitted to the ICU with a confirmed diagnosis of COVID-19. The median age was 69 (interquartile range [IQR] 60-75) years, and 38 (32.5%) were female. At least 1 comorbidity was present in 86 (73.5%) patients. Invasive mechanical ventilation was required in 74 (63.2%) patients. The duration of mechanical ventilation was 13.5 (IQR 8-22) days overall and 11 (IQR 6-16) days for patients successfully discharged from the ICU. Tocilizumab was administered to 4 patients and hydroxychloroquine to 1 patient. As of May 5, 2020, a total of 18 (15.4%) patients had died, 12 (10.3%) remained in the ICU, 16 (13.7%) were discharged from the ICU but remained in hospital, and 71 (60.7%) were discharged home.
INTERPRETATION
In our setting, mortality in critically ill patients with COVID-19 admitted to the ICU was lower than in previously published studies. These data suggest that the prognosis associated with critical illness due to COVID-19 may not be as poor as previously reported.

Identifiants

pubmed: 32461326
pii: cmaj.200794
doi: 10.1503/cmaj.200794
pmc: PMC7828881
doi:

Types de publication

Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

E694-E701

Informations de copyright

© 2020 Joule Inc. or its licensors.

Déclaration de conflit d'intérêts

Competing interests: None declared.

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Auteurs

Anish R Mitra (AR)

Division of Critical Care Medicine, Department of Medicine (Mitra, Wormsbecker, Foster, Karpov, Haljan, Chittock, Kanji, Sekhon, Griesdale), University of British Columbia, Vancouver, BC; Division of Critical Care Medicine, Department of Medicine (Mitra, Haljan), Surrey Memorial Hospital, Surrey, BC; MD Undergraduate Program (Fergusson), University of British Columbia; Quality & Patient Safety (Fergusson, Lloyd-Smith), Vancouver Coastal Health, Vancouver BC; Division of Critical Care Medicine, Department of Medicine (Wormsbecker), Royal Columbian Hospital, New Westminster, BC; Division of Critical Care Medicine, Department of Nurse Practitioners (Crowe), Surrey Memorial Hospital, Surrey, BC; Program of Critical Care (Chittock, Kanji, Sekhon, Griesdale), Vancouver General Hospital; Department of Anesthesiology, Pharmacology & Therapeutics (Griesdale), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Griesdale), Vancouver Coastal Health Research Institute, Vancouver, BC.

Nicholas A Fergusson (NA)

Division of Critical Care Medicine, Department of Medicine (Mitra, Wormsbecker, Foster, Karpov, Haljan, Chittock, Kanji, Sekhon, Griesdale), University of British Columbia, Vancouver, BC; Division of Critical Care Medicine, Department of Medicine (Mitra, Haljan), Surrey Memorial Hospital, Surrey, BC; MD Undergraduate Program (Fergusson), University of British Columbia; Quality & Patient Safety (Fergusson, Lloyd-Smith), Vancouver Coastal Health, Vancouver BC; Division of Critical Care Medicine, Department of Medicine (Wormsbecker), Royal Columbian Hospital, New Westminster, BC; Division of Critical Care Medicine, Department of Nurse Practitioners (Crowe), Surrey Memorial Hospital, Surrey, BC; Program of Critical Care (Chittock, Kanji, Sekhon, Griesdale), Vancouver General Hospital; Department of Anesthesiology, Pharmacology & Therapeutics (Griesdale), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Griesdale), Vancouver Coastal Health Research Institute, Vancouver, BC.

Elisa Lloyd-Smith (E)

Division of Critical Care Medicine, Department of Medicine (Mitra, Wormsbecker, Foster, Karpov, Haljan, Chittock, Kanji, Sekhon, Griesdale), University of British Columbia, Vancouver, BC; Division of Critical Care Medicine, Department of Medicine (Mitra, Haljan), Surrey Memorial Hospital, Surrey, BC; MD Undergraduate Program (Fergusson), University of British Columbia; Quality & Patient Safety (Fergusson, Lloyd-Smith), Vancouver Coastal Health, Vancouver BC; Division of Critical Care Medicine, Department of Medicine (Wormsbecker), Royal Columbian Hospital, New Westminster, BC; Division of Critical Care Medicine, Department of Nurse Practitioners (Crowe), Surrey Memorial Hospital, Surrey, BC; Program of Critical Care (Chittock, Kanji, Sekhon, Griesdale), Vancouver General Hospital; Department of Anesthesiology, Pharmacology & Therapeutics (Griesdale), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Griesdale), Vancouver Coastal Health Research Institute, Vancouver, BC.

Andrew Wormsbecker (A)

Division of Critical Care Medicine, Department of Medicine (Mitra, Wormsbecker, Foster, Karpov, Haljan, Chittock, Kanji, Sekhon, Griesdale), University of British Columbia, Vancouver, BC; Division of Critical Care Medicine, Department of Medicine (Mitra, Haljan), Surrey Memorial Hospital, Surrey, BC; MD Undergraduate Program (Fergusson), University of British Columbia; Quality & Patient Safety (Fergusson, Lloyd-Smith), Vancouver Coastal Health, Vancouver BC; Division of Critical Care Medicine, Department of Medicine (Wormsbecker), Royal Columbian Hospital, New Westminster, BC; Division of Critical Care Medicine, Department of Nurse Practitioners (Crowe), Surrey Memorial Hospital, Surrey, BC; Program of Critical Care (Chittock, Kanji, Sekhon, Griesdale), Vancouver General Hospital; Department of Anesthesiology, Pharmacology & Therapeutics (Griesdale), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Griesdale), Vancouver Coastal Health Research Institute, Vancouver, BC.

Denise Foster (D)

Division of Critical Care Medicine, Department of Medicine (Mitra, Wormsbecker, Foster, Karpov, Haljan, Chittock, Kanji, Sekhon, Griesdale), University of British Columbia, Vancouver, BC; Division of Critical Care Medicine, Department of Medicine (Mitra, Haljan), Surrey Memorial Hospital, Surrey, BC; MD Undergraduate Program (Fergusson), University of British Columbia; Quality & Patient Safety (Fergusson, Lloyd-Smith), Vancouver Coastal Health, Vancouver BC; Division of Critical Care Medicine, Department of Medicine (Wormsbecker), Royal Columbian Hospital, New Westminster, BC; Division of Critical Care Medicine, Department of Nurse Practitioners (Crowe), Surrey Memorial Hospital, Surrey, BC; Program of Critical Care (Chittock, Kanji, Sekhon, Griesdale), Vancouver General Hospital; Department of Anesthesiology, Pharmacology & Therapeutics (Griesdale), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Griesdale), Vancouver Coastal Health Research Institute, Vancouver, BC.

Andrei Karpov (A)

Division of Critical Care Medicine, Department of Medicine (Mitra, Wormsbecker, Foster, Karpov, Haljan, Chittock, Kanji, Sekhon, Griesdale), University of British Columbia, Vancouver, BC; Division of Critical Care Medicine, Department of Medicine (Mitra, Haljan), Surrey Memorial Hospital, Surrey, BC; MD Undergraduate Program (Fergusson), University of British Columbia; Quality & Patient Safety (Fergusson, Lloyd-Smith), Vancouver Coastal Health, Vancouver BC; Division of Critical Care Medicine, Department of Medicine (Wormsbecker), Royal Columbian Hospital, New Westminster, BC; Division of Critical Care Medicine, Department of Nurse Practitioners (Crowe), Surrey Memorial Hospital, Surrey, BC; Program of Critical Care (Chittock, Kanji, Sekhon, Griesdale), Vancouver General Hospital; Department of Anesthesiology, Pharmacology & Therapeutics (Griesdale), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Griesdale), Vancouver Coastal Health Research Institute, Vancouver, BC.

Sarah Crowe (S)

Division of Critical Care Medicine, Department of Medicine (Mitra, Wormsbecker, Foster, Karpov, Haljan, Chittock, Kanji, Sekhon, Griesdale), University of British Columbia, Vancouver, BC; Division of Critical Care Medicine, Department of Medicine (Mitra, Haljan), Surrey Memorial Hospital, Surrey, BC; MD Undergraduate Program (Fergusson), University of British Columbia; Quality & Patient Safety (Fergusson, Lloyd-Smith), Vancouver Coastal Health, Vancouver BC; Division of Critical Care Medicine, Department of Medicine (Wormsbecker), Royal Columbian Hospital, New Westminster, BC; Division of Critical Care Medicine, Department of Nurse Practitioners (Crowe), Surrey Memorial Hospital, Surrey, BC; Program of Critical Care (Chittock, Kanji, Sekhon, Griesdale), Vancouver General Hospital; Department of Anesthesiology, Pharmacology & Therapeutics (Griesdale), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Griesdale), Vancouver Coastal Health Research Institute, Vancouver, BC.

Greg Haljan (G)

Division of Critical Care Medicine, Department of Medicine (Mitra, Wormsbecker, Foster, Karpov, Haljan, Chittock, Kanji, Sekhon, Griesdale), University of British Columbia, Vancouver, BC; Division of Critical Care Medicine, Department of Medicine (Mitra, Haljan), Surrey Memorial Hospital, Surrey, BC; MD Undergraduate Program (Fergusson), University of British Columbia; Quality & Patient Safety (Fergusson, Lloyd-Smith), Vancouver Coastal Health, Vancouver BC; Division of Critical Care Medicine, Department of Medicine (Wormsbecker), Royal Columbian Hospital, New Westminster, BC; Division of Critical Care Medicine, Department of Nurse Practitioners (Crowe), Surrey Memorial Hospital, Surrey, BC; Program of Critical Care (Chittock, Kanji, Sekhon, Griesdale), Vancouver General Hospital; Department of Anesthesiology, Pharmacology & Therapeutics (Griesdale), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Griesdale), Vancouver Coastal Health Research Institute, Vancouver, BC.

Dean R Chittock (DR)

Division of Critical Care Medicine, Department of Medicine (Mitra, Wormsbecker, Foster, Karpov, Haljan, Chittock, Kanji, Sekhon, Griesdale), University of British Columbia, Vancouver, BC; Division of Critical Care Medicine, Department of Medicine (Mitra, Haljan), Surrey Memorial Hospital, Surrey, BC; MD Undergraduate Program (Fergusson), University of British Columbia; Quality & Patient Safety (Fergusson, Lloyd-Smith), Vancouver Coastal Health, Vancouver BC; Division of Critical Care Medicine, Department of Medicine (Wormsbecker), Royal Columbian Hospital, New Westminster, BC; Division of Critical Care Medicine, Department of Nurse Practitioners (Crowe), Surrey Memorial Hospital, Surrey, BC; Program of Critical Care (Chittock, Kanji, Sekhon, Griesdale), Vancouver General Hospital; Department of Anesthesiology, Pharmacology & Therapeutics (Griesdale), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Griesdale), Vancouver Coastal Health Research Institute, Vancouver, BC.

Hussein D Kanji (HD)

Division of Critical Care Medicine, Department of Medicine (Mitra, Wormsbecker, Foster, Karpov, Haljan, Chittock, Kanji, Sekhon, Griesdale), University of British Columbia, Vancouver, BC; Division of Critical Care Medicine, Department of Medicine (Mitra, Haljan), Surrey Memorial Hospital, Surrey, BC; MD Undergraduate Program (Fergusson), University of British Columbia; Quality & Patient Safety (Fergusson, Lloyd-Smith), Vancouver Coastal Health, Vancouver BC; Division of Critical Care Medicine, Department of Medicine (Wormsbecker), Royal Columbian Hospital, New Westminster, BC; Division of Critical Care Medicine, Department of Nurse Practitioners (Crowe), Surrey Memorial Hospital, Surrey, BC; Program of Critical Care (Chittock, Kanji, Sekhon, Griesdale), Vancouver General Hospital; Department of Anesthesiology, Pharmacology & Therapeutics (Griesdale), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Griesdale), Vancouver Coastal Health Research Institute, Vancouver, BC.

Mypinder S Sekhon (MS)

Division of Critical Care Medicine, Department of Medicine (Mitra, Wormsbecker, Foster, Karpov, Haljan, Chittock, Kanji, Sekhon, Griesdale), University of British Columbia, Vancouver, BC; Division of Critical Care Medicine, Department of Medicine (Mitra, Haljan), Surrey Memorial Hospital, Surrey, BC; MD Undergraduate Program (Fergusson), University of British Columbia; Quality & Patient Safety (Fergusson, Lloyd-Smith), Vancouver Coastal Health, Vancouver BC; Division of Critical Care Medicine, Department of Medicine (Wormsbecker), Royal Columbian Hospital, New Westminster, BC; Division of Critical Care Medicine, Department of Nurse Practitioners (Crowe), Surrey Memorial Hospital, Surrey, BC; Program of Critical Care (Chittock, Kanji, Sekhon, Griesdale), Vancouver General Hospital; Department of Anesthesiology, Pharmacology & Therapeutics (Griesdale), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Griesdale), Vancouver Coastal Health Research Institute, Vancouver, BC.

Donald E G Griesdale (DEG)

Division of Critical Care Medicine, Department of Medicine (Mitra, Wormsbecker, Foster, Karpov, Haljan, Chittock, Kanji, Sekhon, Griesdale), University of British Columbia, Vancouver, BC; Division of Critical Care Medicine, Department of Medicine (Mitra, Haljan), Surrey Memorial Hospital, Surrey, BC; MD Undergraduate Program (Fergusson), University of British Columbia; Quality & Patient Safety (Fergusson, Lloyd-Smith), Vancouver Coastal Health, Vancouver BC; Division of Critical Care Medicine, Department of Medicine (Wormsbecker), Royal Columbian Hospital, New Westminster, BC; Division of Critical Care Medicine, Department of Nurse Practitioners (Crowe), Surrey Memorial Hospital, Surrey, BC; Program of Critical Care (Chittock, Kanji, Sekhon, Griesdale), Vancouver General Hospital; Department of Anesthesiology, Pharmacology & Therapeutics (Griesdale), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Griesdale), Vancouver Coastal Health Research Institute, Vancouver, BC donald.griesdale@ubc.ca.

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