Covid-19 in Critically Ill Patients in the Seattle Region — Case Series - NEJM

30-3-2020; 10.1056/NEJMoa2004500
By: Bhatraju, et al

Aim
Describe the demographic characteristics, coexisting conditions, imaging findings, and outcomes among critically ill patients with Covid-19 in Seattle

Summary

• Laboratory confirmed covid-19 patients admitted to 9 Seattle hospitals ICUs between 24-2 and 9-3 were included
• 24 adults were included:
  • Mean age: 64 years, 63% men
  • Mean duration of symptoms before hospital admission: 7dys
  • Mst common symptoms on admission to the hospital were shortness of breath and cough, each of which occurred in 21 patients (88%). Documented fever was present in 12 patients (50%) on presentation at the hospital.
  • 58% had DM, 21% CKD, 14% asthma.
  • 75% had lymphopenia at presentation
  • 100% of chest x-rays showed bilateral pulmonary opacities at presentation
  • 4 of 5 conducted CT’s showed ground-glass opacities.
  • None of the patients had co-infection with another respiratory virus (e.g. influenza)
  • 75% received mechanical ventilation

     

    • PaO2/FIO2 ratios were consistent with moderate to severe ARDS
    • Mean FI02 on day 1 was: 0.9 improving to 0.6 on day 3. 
    • Peep on day 1: 13 cm/H2O remaining consistent in first 3 days
    • 28% of patients was placed in prone position
    • 39% received neuromuscular blockade
    • 28% received inhaled pulmonary vasodilation
  • 71% were hypotensive requiring vasopressors
  • 50% of patients had died as of March 23, 17% was discharged from the ICU
  • Patients older than 65 years were more likely to die. 
  • Median length of hospital stay among survivors was 17 day and median length of ICU stay among survivors was 14 days (10 days mechanical ventilation, underestimation since patients were still intubated at March 23)
  • See figure for individual patient outcomes: