Your browser doesn't support javascript.
Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy.
Grasselli, Giacomo; Zangrillo, Alberto; Zanella, Alberto; Antonelli, Massimo; Cabrini, Luca; Castelli, Antonio; Cereda, Danilo; Coluccello, Antonio; Foti, Giuseppe; Fumagalli, Roberto; Iotti, Giorgio; Latronico, Nicola; Lorini, Luca; Merler, Stefano; Natalini, Giuseppe; Piatti, Alessandra; Ranieri, Marco Vito; Scandroglio, Anna Mara; Storti, Enrico; Cecconi, Maurizio; Pesenti, Antonio.
  • Grasselli G; Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Zangrillo A; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Zanella A; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Antonelli M; Vita-Salute San Raffaele University Milan, Italy.
  • Cabrini L; Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Castelli A; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Cereda D; Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Coluccello A; Università Cattolica del Sacro Cuore, Rome, Italy.
  • Foti G; Università degli Studi dell'Insubria and Azienda Ospedaliera Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
  • Fumagalli R; Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario, University of Milan, Milan, Italy.
  • Iotti G; DG Welfare, Lombardy Region, Milan, Italy.
  • Latronico N; Department of Anesthesiology and Intensive Care, ASST Cremona - Ospedale di Cremona, Cremona, Italy.
  • Lorini L; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
  • Merler S; Department of Anesthesia and Intensive Care Medicine, ASST Monza, Monza, Italy.
  • Natalini G; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
  • Piatti A; Department of Anaesthesia and Intensive Care Unit, IRCCS San Matteo Hospital and University of Pavia, Pavia, Italy.
  • Ranieri MV; Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Spedali Civili University Hospital, Brescia, Italy.
  • Scandroglio AM; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
  • Storti E; Department of Anaesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy.
  • Cecconi M; Bruno Kessler Foundation, Trento, Italy.
  • Pesenti A; Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, Brescia, Italy.
JAMA ; 323(16): 1574-1581, 2020 04 28.
Статья в английский | MEDLINE | ID: covidwho-1453471
ABSTRACT
Importance In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited.

Objective:

To characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy. Design, Setting, and

Participants:

Retrospective case series of 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinator center (Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network and treated at one of the ICUs of the 72 hospitals in this network between February 20 and March 18, 2020. Date of final follow-up was March 25, 2020. Exposures SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs. Main Outcomes and

Measures:

Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center on an electronic worksheet during telephone calls by the staff of the COVID-19 Lombardy ICU Network.

Results:

Of the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2O, and Fio2 was greater than 50% in 89% of patients. The median Pao2/Fio2 was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n = 503 aged ≤63 years) and older patients (n = 514 aged ≥64 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2O, respectively; median difference, 0 [95% CI, 0-0]; P = .94). Median Fio2 was lower in younger patients 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, -10% [95% CI, -14% to 6%]; P = .006), and median Pao2/Fio2 was higher in younger patients 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, -8 to 22]; P = .02). Patients with hypertension (n = 509) were older than those without hypertension (n = 526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68]; P < .001) and had lower Pao2/Fio2 (median [IQR], 146 [105-214] vs 173 [120-222]; median difference, -27 [95% CI, -42 to -12]; P = .005). Among the 1581 patients with ICU disposition data available as of March 25, 2020, 920 patients (58% [95% CI, 56%-61%]) were still in the ICU, 256 (16% [95% CI, 14%-18%]) were discharged from the ICU, and 405 (26% [95% CI, 23%-28%]) had died in the ICU. Older patients (n = 786; age ≥64 years) had higher mortality than younger patients (n = 795; age ≤63 years) (36% vs 15%; difference, 21% [95% CI, 17%-26%]; P < .001). Conclusions and Relevance In this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%.
Тема - темы

Полный текст: Имеется в наличии Коллекция: Международные базы данных база данных: MEDLINE Основная тема: Pneumonia, Viral / Positive-Pressure Respiration / Hospital Mortality / Coronavirus Infections / Critical Care / Betacoronavirus / Intensive Care Units Тип исследования: Когортное исследование / Наблюдательное исследование / Прогностическое исследование Пределы темы: Подростки / Взрослые / Пожилые / Женщины / Люди / Мужчины / Middle aged / Молодой взрослый Страна как тема: Европа Язык: английский Журнал: JAMA Год: 2020 Тип: Статья Аффилированная страна: Jama.2020.5394

Документы, близкие по теме

MEDLINE

...
LILACS

LIS


Полный текст: Имеется в наличии Коллекция: Международные базы данных база данных: MEDLINE Основная тема: Pneumonia, Viral / Positive-Pressure Respiration / Hospital Mortality / Coronavirus Infections / Critical Care / Betacoronavirus / Intensive Care Units Тип исследования: Когортное исследование / Наблюдательное исследование / Прогностическое исследование Пределы темы: Подростки / Взрослые / Пожилые / Женщины / Люди / Мужчины / Middle aged / Молодой взрослый Страна как тема: Европа Язык: английский Журнал: JAMA Год: 2020 Тип: Статья Аффилированная страна: Jama.2020.5394