COVID-19 - Characteristics and clinical outcomes of patients admitted to Intensive Care Units


  • Daniela Ovadia — Agenzia Zoe
  • Univadis Medical News
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Takeaway

  • Patients with laboratory-confirmed COVID-19 admitted to Intensive Care Units (ICUs) in Lombardy Region (Italy) were mainly older men.
  • At least one comorbidity was present in more than 2/3 of the cases.
  • The vast majority of the patients needed respiratory support, invasive mechanical ventilation in most cases.
  • Mortality in ICU was 26%.

Why this matters?

  • The percentage of patients in need of ICU care has varied from 5% to 32% in China, being 9% in Italy up through March 18, 2020.
  • ICU beds and the provision of intensive care are limited in many countries.
  • Knowing the baseline characteristics and outcomes of critically ill patients could help planning efforts to address local outbreaks.

Study design

  • Retrospective case series including 1,591 consecutive patients with laboratory-confirmed COVID-19.
  • Patients referred for ICU admission to Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy, the coordinator center of the COVID-19 Lombardy ICU Network and treated in one of the 72 hospitals from the Network.
  • Final follow-up: March 25, 2020.
  • Demographic and clinical data collected and recorded by the coordinator center during telephone calls by the staff of the Network.
  • Funding: Institutional funding of the Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy.

Key results

  • Patients: median age 63 years, 82% male.
  • 68% of patients had at least 1 comorbidity and 49% had hypertension (data on 1,043 patients).
  • 99% of patients needed respiratory support: 88% mechanical ventilation, 11% non-invasive ventilation (data on 1300 patients).
  • The median positive end-expiratory pressure (PEEP) was not different between younger and older (64 years or older), reaching 14 cm H2O.
  • As of March 25, 2020, 58% were still in the ICU, 16% were discharged from and 26% had died in the ICU (data on 1,581 patients).
  • Mortality was higher in older patients (36% in ≥64 years vs 15% in ≤63 years).

Limitations

  • Retrospective study, with data collected via telephone.
  • Detailed information, such as baseline medication use, not available.
  • Relatively short follow-up.
  • Large amounts of missing data for some outcomes.