Rapid clinical evolution for COVID-19 translates into early hospital admission and unfavourable outcome: a preliminary report.
COVID-19
SARS-CoV-2
acute respiratory distress syndrome
critical care
invasive ventilation
mortality
prone position
retrospective cohort study
Journal
Multidisciplinary respiratory medicine
ISSN: 1828-695X
Titre abrégé: Multidiscip Respir Med
Pays: Italy
ID NLM: 101477642
Informations de publication
Date de publication:
15 Jan 2021
15 Jan 2021
Historique:
received:
15
12
2020
accepted:
23
02
2021
entrez:
28
4
2021
pubmed:
29
4
2021
medline:
29
4
2021
Statut:
epublish
Résumé
A wide range of mortality rates has been reported in COVID-19 patients on the intensive care unit. We wanted to describe the clinical course and determine the mortality rate in our institution's intensive care units. To this end, we performed a retrospective cohort study of 50 COVID-19 patients admitted to the ICU at a large German tertiary university hospital. Clinical features are reported with a focus on ICU interventions, such as mechanical ventilation, prone positioning and extracorporeal organ support. Outcome is presented using a 7-point ordinal scale on day 28 and 60 following ICU admission. The median age was 64 years, 78% were male. LDH and D-Dimers were elevated, and patients were low on Vitamin D. ARDS incidence was 75%, and 43/50 patients needed invasive ventilation. 22/50 patients intermittently needed prone positioning, and 7/50 required ECMO. The interval from onset of the first symptoms to admission to the hospital and to the ICU was shorter in non-survivors than in survivors. By day 60 after ICU admission, 52% of the patients had been discharged. 60-day mortality rate was 32%; 37% for ventilated patients, and 42% for those requiring both: ventilation and renal replacement therapy. Early deterioration might be seen as a warning signal for unfavourable outcome. Lung-protective ventilation including prone positioning remain the mainstay of the treatment.
Sections du résumé
BACKGROUND
BACKGROUND
A wide range of mortality rates has been reported in COVID-19 patients on the intensive care unit. We wanted to describe the clinical course and determine the mortality rate in our institution's intensive care units.
METHODS
METHODS
To this end, we performed a retrospective cohort study of 50 COVID-19 patients admitted to the ICU at a large German tertiary university hospital. Clinical features are reported with a focus on ICU interventions, such as mechanical ventilation, prone positioning and extracorporeal organ support. Outcome is presented using a 7-point ordinal scale on day 28 and 60 following ICU admission.
RESULTS
RESULTS
The median age was 64 years, 78% were male. LDH and D-Dimers were elevated, and patients were low on Vitamin D. ARDS incidence was 75%, and 43/50 patients needed invasive ventilation. 22/50 patients intermittently needed prone positioning, and 7/50 required ECMO. The interval from onset of the first symptoms to admission to the hospital and to the ICU was shorter in non-survivors than in survivors. By day 60 after ICU admission, 52% of the patients had been discharged. 60-day mortality rate was 32%; 37% for ventilated patients, and 42% for those requiring both: ventilation and renal replacement therapy.
CONCLUSIONS
CONCLUSIONS
Early deterioration might be seen as a warning signal for unfavourable outcome. Lung-protective ventilation including prone positioning remain the mainstay of the treatment.
Identifiants
pubmed: 33907624
doi: 10.4081/mrm.2021.744
pmc: PMC8056325
doi:
Types de publication
Journal Article
Langues
eng
Pagination
744Informations de copyright
©Copyright: the Author(s).
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