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

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Graselli G et al. JAMA. doi:10.1001/jama.2020.5394

Salient points:

This study was of baseline characteristics and outcomes of patients with laboratory-confirmed SARS-CoV-2 infection admitted to ICUs in Lombardy, Italy, one of the most affected areas in Italy and the world.

Retrospective case series of 1591 critically ill patients Covid 19 patients over 1 month

  • 99% required respiratory support
  • 88% needed endotracheal intubation
  • 11% needed NIV
  • ICU mortality was 26%.

Detailed Summary:

Lomabardy in Italy was one if the most affected areas in the ongoing Covid-19 pandemic The authors report a retrospective case series of 1591 consecutive patients

with laboratory-confirmed COVID-19 referred for ICU admission in the Lombardy ICU Network of 72 hospitals between February 20 and March 18, 2020.

They report demographic and clinical data including clinical management, respiratory failure, and patient mortality.

Results: 1591 patients were included in the study

Median (IQR) age was 63 (56-70) years, and male predominance was noted (82%).

at least 1 comorbidity was seen in 709 (68%) almost half (49%) had hypertension.

1287 (99%[95%CI, 98%-99%]) needed respiratory support, of whom 1150 (88%[95%CI, 87%-90%]) received mechanical ventilation and 137 (11% [95%CI, 9%-12%]) received NIV.

The median PEEP was 14 (IQR, 12-16) cm H2O, and FIO2 was >  50% in

89%of patients. PEEP was not significantly different between older and younger patients

Younger  patients had better oxygen status than older patients [ PaO2/FiO2 = 163.5 (IQR, 120-230) vs 156 (IQR, 110-205, P = .02 ] and needed less oxygen support than older patients (Median FIO2 60%vs 70%. P = .006),

Mortality and morbidity were high: At the time of writing of the paper, 26% had died in the ICU, 58% patients were still in the ICU, 16% were discharged from the ICU.

Older patients had higher mortality than younger patients – 36%vs 15%, P < .001). 

Conclusions:

A large percentage of ICU patients with CoVID 19 infection admitted to ICUs in Lombardy Italy needed mechanical ventilation (88%). Older individuals fared worse, starting with poorer oxygen status, needing higher PEEP and suffering higher mortality. While overall mortality was high (26%),it was even higher in older than in younger patients (36% vs 15%).

Reference Link : https://jamanetwork.com/journals/jama/fullarticle/2764365

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