Tags

Type your tag names separated by a space and hit enter

Covid-19 in Critically Ill Patients in the Seattle Region - Case Series.
N Engl J Med. 2020 05 21; 382(21):2012-2022.NEJM

Abstract

BACKGROUND

Community transmission of coronavirus 2019 (Covid-19) was detected in the state of Washington in February 2020.

METHODS

We identified patients from nine Seattle-area hospitals who were admitted to the intensive care unit (ICU) with confirmed infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Clinical data were obtained through review of medical records. The data reported here are those available through March 23, 2020. Each patient had at least 14 days of follow-up.

RESULTS

We identified 24 patients with confirmed Covid-19. The mean (±SD) age of the patients was 64±18 years, 63% were men, and symptoms began 7±4 days before admission. The most common symptoms were cough and shortness of breath; 50% of patients had fever on admission, and 58% had diabetes mellitus. All the patients were admitted for hypoxemic respiratory failure; 75% (18 patients) needed mechanical ventilation. Most of the patients (17) also had hypotension and needed vasopressors. No patient tested positive for influenza A, influenza B, or other respiratory viruses. Half the patients (12) died between ICU day 1 and day 18, including 4 patients who had a do-not-resuscitate order on admission. Of the 12 surviving patients, 5 were discharged home, 4 were discharged from the ICU but remained in the hospital, and 3 continued to receive mechanical ventilation in the ICU.

CONCLUSIONS

During the first 3 weeks of the Covid-19 outbreak in the Seattle area, the most common reasons for admission to the ICU were hypoxemic respiratory failure leading to mechanical ventilation, hypotension requiring vasopressor treatment, or both. Mortality among these critically ill patients was high. (Funded by the National Institutes of Health.).

Authors+Show Affiliations

From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (P.K.B., B.J.G., M.N., R.K., M.M.W., L.E., P.A.K., T.E.W., A.L., C.M.), the Departments of Laboratory Medicine (K.R.J., A.K.N., A.L.G.) and Radiology (S.P.), and the Division of Allergy and Infectious Disease (J.D.G.), University of Washington, the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (K.R.J., A.K.N., A.L.G.), the Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center (A.G.), and the Divisions of Pulmonary and Critical Care (C.R.D., S.O.) and Infectious Disease (J.D.G.), Swedish Medical Center - all in Seattle.From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (P.K.B., B.J.G., M.N., R.K., M.M.W., L.E., P.A.K., T.E.W., A.L., C.M.), the Departments of Laboratory Medicine (K.R.J., A.K.N., A.L.G.) and Radiology (S.P.), and the Division of Allergy and Infectious Disease (J.D.G.), University of Washington, the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (K.R.J., A.K.N., A.L.G.), the Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center (A.G.), and the Divisions of Pulmonary and Critical Care (C.R.D., S.O.) and Infectious Disease (J.D.G.), Swedish Medical Center - all in Seattle.From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (P.K.B., B.J.G., M.N., R.K., M.M.W., L.E., P.A.K., T.E.W., A.L., C.M.), the Departments of Laboratory Medicine (K.R.J., A.K.N., A.L.G.) and Radiology (S.P.), and the Division of Allergy and Infectious Disease (J.D.G.), University of Washington, the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (K.R.J., A.K.N., A.L.G.), the Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center (A.G.), and the Divisions of Pulmonary and Critical Care (C.R.D., S.O.) and Infectious Disease (J.D.G.), Swedish Medical Center - all in Seattle.From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (P.K.B., B.J.G., M.N., R.K., M.M.W., L.E., P.A.K., T.E.W., A.L., C.M.), the Departments of Laboratory Medicine (K.R.J., A.K.N., A.L.G.) and Radiology (S.P.), and the Division of Allergy and Infectious Disease (J.D.G.), University of Washington, the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (K.R.J., A.K.N., A.L.G.), the Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center (A.G.), and the Divisions of Pulmonary and Critical Care (C.R.D., S.O.) and Infectious Disease (J.D.G.), Swedish Medical Center - all in Seattle.From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (P.K.B., B.J.G., M.N., R.K., M.M.W., L.E., P.A.K., T.E.W., A.L., C.M.), the Departments of Laboratory Medicine (K.R.J., A.K.N., A.L.G.) and Radiology (S.P.), and the Division of Allergy and Infectious Disease (J.D.G.), University of Washington, the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (K.R.J., A.K.N., A.L.G.), the Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center (A.G.), and the Divisions of Pulmonary and Critical Care (C.R.D., S.O.) and Infectious Disease (J.D.G.), Swedish Medical Center - all in Seattle.From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (P.K.B., B.J.G., M.N., R.K., M.M.W., L.E., P.A.K., T.E.W., A.L., C.M.), the Departments of Laboratory Medicine (K.R.J., A.K.N., A.L.G.) and Radiology (S.P.), and the Division of Allergy and Infectious Disease (J.D.G.), University of Washington, the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (K.R.J., A.K.N., A.L.G.), the Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center (A.G.), and the Divisions of Pulmonary and Critical Care (C.R.D., S.O.) and Infectious Disease (J.D.G.), Swedish Medical Center - all in Seattle.From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (P.K.B., B.J.G., M.N., R.K., M.M.W., L.E., P.A.K., T.E.W., A.L., C.M.), the Departments of Laboratory Medicine (K.R.J., A.K.N., A.L.G.) and Radiology (S.P.), and the Division of Allergy and Infectious Disease (J.D.G.), University of Washington, the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (K.R.J., A.K.N., A.L.G.), the Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center (A.G.), and the Divisions of Pulmonary and Critical Care (C.R.D., S.O.) and Infectious Disease (J.D.G.), Swedish Medical Center - all in Seattle.From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (P.K.B., B.J.G., M.N., R.K., M.M.W., L.E., P.A.K., T.E.W., A.L., C.M.), the Departments of Laboratory Medicine (K.R.J., A.K.N., A.L.G.) and Radiology (S.P.), and the Division of Allergy and Infectious Disease (J.D.G.), University of Washington, the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (K.R.J., A.K.N., A.L.G.), the Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center (A.G.), and the Divisions of Pulmonary and Critical Care (C.R.D., S.O.) and Infectious Disease (J.D.G.), Swedish Medical Center - all in Seattle.From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (P.K.B., B.J.G., M.N., R.K., M.M.W., L.E., P.A.K., T.E.W., A.L., C.M.), the Departments of Laboratory Medicine (K.R.J., A.K.N., A.L.G.) and Radiology (S.P.), and the Division of Allergy and Infectious Disease (J.D.G.), University of Washington, the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (K.R.J., A.K.N., A.L.G.), the Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center (A.G.), and the Divisions of Pulmonary and Critical Care (C.R.D., S.O.) and Infectious Disease (J.D.G.), Swedish Medical Center - all in Seattle.From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (P.K.B., B.J.G., M.N., R.K., M.M.W., L.E., P.A.K., T.E.W., A.L., C.M.), the Departments of Laboratory Medicine (K.R.J., A.K.N., A.L.G.) and Radiology (S.P.), and the Division of Allergy and Infectious Disease (J.D.G.), University of Washington, the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (K.R.J., A.K.N., A.L.G.), the Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center (A.G.), and the Divisions of Pulmonary and Critical Care (C.R.D., S.O.) and Infectious Disease (J.D.G.), Swedish Medical Center - all in Seattle.From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (P.K.B., B.J.G., M.N., R.K., M.M.W., L.E., P.A.K., T.E.W., A.L., C.M.), the Departments of Laboratory Medicine (K.R.J., A.K.N., A.L.G.) and Radiology (S.P.), and the Division of Allergy and Infectious Disease (J.D.G.), University of Washington, the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (K.R.J., A.K.N., A.L.G.), the Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center (A.G.), and the Divisions of Pulmonary and Critical Care (C.R.D., S.O.) and Infectious Disease (J.D.G.), Swedish Medical Center - all in Seattle.From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (P.K.B., B.J.G., M.N., R.K., M.M.W., L.E., P.A.K., T.E.W., A.L., C.M.), the Departments of Laboratory Medicine (K.R.J., A.K.N., A.L.G.) and Radiology (S.P.), and the Division of Allergy and Infectious Disease (J.D.G.), University of Washington, the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (K.R.J., A.K.N., A.L.G.), the Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center (A.G.), and the Divisions of Pulmonary and Critical Care (C.R.D., S.O.) and Infectious Disease (J.D.G.), Swedish Medical Center - all in Seattle.From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (P.K.B., B.J.G., M.N., R.K., M.M.W., L.E., P.A.K., T.E.W., A.L., C.M.), the Departments of Laboratory Medicine (K.R.J., A.K.N., A.L.G.) and Radiology (S.P.), and the Division of Allergy and Infectious Disease (J.D.G.), University of Washington, the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (K.R.J., A.K.N., A.L.G.), the Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center (A.G.), and the Divisions of Pulmonary and Critical Care (C.R.D., S.O.) and Infectious Disease (J.D.G.), Swedish Medical Center - all in Seattle.From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (P.K.B., B.J.G., M.N., R.K., M.M.W., L.E., P.A.K., T.E.W., A.L., C.M.), the Departments of Laboratory Medicine (K.R.J., A.K.N., A.L.G.) and Radiology (S.P.), and the Division of Allergy and Infectious Disease (J.D.G.), University of Washington, the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (K.R.J., A.K.N., A.L.G.), the Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center (A.G.), and the Divisions of Pulmonary and Critical Care (C.R.D., S.O.) and Infectious Disease (J.D.G.), Swedish Medical Center - all in Seattle.From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (P.K.B., B.J.G., M.N., R.K., M.M.W., L.E., P.A.K., T.E.W., A.L., C.M.), the Departments of Laboratory Medicine (K.R.J., A.K.N., A.L.G.) and Radiology (S.P.), and the Division of Allergy and Infectious Disease (J.D.G.), University of Washington, the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (K.R.J., A.K.N., A.L.G.), the Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center (A.G.), and the Divisions of Pulmonary and Critical Care (C.R.D., S.O.) and Infectious Disease (J.D.G.), Swedish Medical Center - all in Seattle.From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (P.K.B., B.J.G., M.N., R.K., M.M.W., L.E., P.A.K., T.E.W., A.L., C.M.), the Departments of Laboratory Medicine (K.R.J., A.K.N., A.L.G.) and Radiology (S.P.), and the Division of Allergy and Infectious Disease (J.D.G.), University of Washington, the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (K.R.J., A.K.N., A.L.G.), the Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center (A.G.), and the Divisions of Pulmonary and Critical Care (C.R.D., S.O.) and Infectious Disease (J.D.G.), Swedish Medical Center - all in Seattle.From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (P.K.B., B.J.G., M.N., R.K., M.M.W., L.E., P.A.K., T.E.W., A.L., C.M.), the Departments of Laboratory Medicine (K.R.J., A.K.N., A.L.G.) and Radiology (S.P.), and the Division of Allergy and Infectious Disease (J.D.G.), University of Washington, the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (K.R.J., A.K.N., A.L.G.), the Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center (A.G.), and the Divisions of Pulmonary and Critical Care (C.R.D., S.O.) and Infectious Disease (J.D.G.), Swedish Medical Center - all in Seattle.From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (P.K.B., B.J.G., M.N., R.K., M.M.W., L.E., P.A.K., T.E.W., A.L., C.M.), the Departments of Laboratory Medicine (K.R.J., A.K.N., A.L.G.) and Radiology (S.P.), and the Division of Allergy and Infectious Disease (J.D.G.), University of Washington, the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (K.R.J., A.K.N., A.L.G.), the Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center (A.G.), and the Divisions of Pulmonary and Critical Care (C.R.D., S.O.) and Infectious Disease (J.D.G.), Swedish Medical Center - all in Seattle.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

32227758

Citation

Bhatraju, Pavan K., et al. "Covid-19 in Critically Ill Patients in the Seattle Region - Case Series." The New England Journal of Medicine, vol. 382, no. 21, 2020, pp. 2012-2022.
Bhatraju PK, Ghassemieh BJ, Nichols M, et al. Covid-19 in Critically Ill Patients in the Seattle Region - Case Series. N Engl J Med. 2020;382(21):2012-2022.
Bhatraju, P. K., Ghassemieh, B. J., Nichols, M., Kim, R., Jerome, K. R., Nalla, A. K., Greninger, A. L., Pipavath, S., Wurfel, M. M., Evans, L., Kritek, P. A., West, T. E., Luks, A., Gerbino, A., Dale, C. R., Goldman, J. D., O'Mahony, S., & Mikacenic, C. (2020). Covid-19 in Critically Ill Patients in the Seattle Region - Case Series. The New England Journal of Medicine, 382(21), 2012-2022. https://doi.org/10.1056/NEJMoa2004500
Bhatraju PK, et al. Covid-19 in Critically Ill Patients in the Seattle Region - Case Series. N Engl J Med. 2020 05 21;382(21):2012-2022. PubMed PMID: 32227758.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Covid-19 in Critically Ill Patients in the Seattle Region - Case Series. AU - Bhatraju,Pavan K, AU - Ghassemieh,Bijan J, AU - Nichols,Michelle, AU - Kim,Richard, AU - Jerome,Keith R, AU - Nalla,Arun K, AU - Greninger,Alexander L, AU - Pipavath,Sudhakar, AU - Wurfel,Mark M, AU - Evans,Laura, AU - Kritek,Patricia A, AU - West,T Eoin, AU - Luks,Andrew, AU - Gerbino,Anthony, AU - Dale,Chris R, AU - Goldman,Jason D, AU - O'Mahony,Shane, AU - Mikacenic,Carmen, Y1 - 2020/03/30/ PY - 2020/4/1/pubmed PY - 2020/5/27/medline PY - 2020/4/1/entrez SP - 2012 EP - 2022 JF - The New England journal of medicine JO - N Engl J Med VL - 382 IS - 21 N2 - BACKGROUND: Community transmission of coronavirus 2019 (Covid-19) was detected in the state of Washington in February 2020. METHODS: We identified patients from nine Seattle-area hospitals who were admitted to the intensive care unit (ICU) with confirmed infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Clinical data were obtained through review of medical records. The data reported here are those available through March 23, 2020. Each patient had at least 14 days of follow-up. RESULTS: We identified 24 patients with confirmed Covid-19. The mean (±SD) age of the patients was 64±18 years, 63% were men, and symptoms began 7±4 days before admission. The most common symptoms were cough and shortness of breath; 50% of patients had fever on admission, and 58% had diabetes mellitus. All the patients were admitted for hypoxemic respiratory failure; 75% (18 patients) needed mechanical ventilation. Most of the patients (17) also had hypotension and needed vasopressors. No patient tested positive for influenza A, influenza B, or other respiratory viruses. Half the patients (12) died between ICU day 1 and day 18, including 4 patients who had a do-not-resuscitate order on admission. Of the 12 surviving patients, 5 were discharged home, 4 were discharged from the ICU but remained in the hospital, and 3 continued to receive mechanical ventilation in the ICU. CONCLUSIONS: During the first 3 weeks of the Covid-19 outbreak in the Seattle area, the most common reasons for admission to the ICU were hypoxemic respiratory failure leading to mechanical ventilation, hypotension requiring vasopressor treatment, or both. Mortality among these critically ill patients was high. (Funded by the National Institutes of Health.). SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/32227758/Covid_19_in_Critically_Ill_Patients_in_the_Seattle_Region___Case_Series_ L2 - https://www.nejm.org/doi/10.1056/NEJMoa2004500?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -