15 april 2020

Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy - JAMA

6-4-2020; doi:10.1001/jama.2020.5394
By: G. Grasselli, et al.

Aim
Describe clinical characteristics of COVID-19 patients admitted to the ICUs of Lombardy.

Keys

Clinical characteristics of 1591 ICU-patients in Lombardy are described
99% required respiratory support, 88% intubation and mechanical ventilation and 11% non-invasive ventilation.
ICU mortality was 26% while 58% of patients was still admitted to the ICU at study closure.

Summary

All COVID-19 patients (= positive RT-PCR of nasal and pharyngeal swabs) admitted to the ICU’s of 72 Lombardy between 20-2 and 18-3 were included.
1591 inclusions, 82% male, median age 63, 23% was 71 years or older, 13% was younger than 50.
Hypertension most common comorbidity (49%). Cardiovascular disease and hypercholesterolemia were second and third most common.
99% of ICU admitted patients required (non)-invasive respiratory support, 88% were intubated and mechanically ventilated. Median PEEP was 14 cm H20. 89% required FiO2 of at least 50%. 12% required 100%. 27% required prone ventilation en 1% ECMO at admission
Hypertensive patients had higher ventilation requirements
58% of patients were still at ICU when the study closed, 16% were discharged from ICU and 26% had died (underestimation since 58% of patients was still on ICU at study closure). Mortality rates were higher among elderly and hypertensive patients.
Median ICU length of stay was 8 days for discharged patients. And 10 days for patients still admitted (underestimation).
Mechanical ventilation rates in this study is much higher compared to other literature which is probably due to non-invasively ventilated patients being treated on wards in Italy and therefore not requiring ICU admittance (and exclusion of the current study).
63 is also the median age of all infected Italian patients indicating older age is not a risk factor for ICU admittance.