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SARS-CoV-2 in Spanish Intensive Care Units: Early experience with 15-day survival in Vitoria.
Anaesth Crit Care Pain Med. 2020 10; 39(5):553-561.AC

Abstract

PURPOSE

Community transmission of SARS-CoV-2 was detected in Spain in February 2020, with 216% intensive care unit (ICU) capacity expanded in Vitoria by March 18th, 2020.

METHODS

We identified patients from the two public hospitals in Vitoria who were admitted to ICU with confirmed infection by SARS-CoV-2. Data reported here were available in April 6th, 2020. Mortality was assessed in those who completed 15-days of ICU stay.

RESULTS

We identified 48 patients (27 males) with confirmed SARS-CoV-2. Median [interquartile range (IQR)] age of patients was 63 [51-75] years. Symptoms began a median of 7 [5-12] days before ICU admission. The most common comorbidities identified were obesity (48%), arterial hypertension (44%) and chronic lung disease (37%). All patients were admitted by hypoxemic respiratory failure and none received non-invasive mechanical ventilation. Forty-five (94%) underwent intubation, 3 (6%) high flow nasal therapy (HFNT), 1 (2%) extracorporeal membrane oxygenation (ECMO) and 22 (46%) required prone position. After 15 days, 14/45 (31%) intubated patients died (13% within one week), 10/45 (22%) were extubated, and 21/45 (47%) underwent mechanical ventilation. Six patients had documented super-infection. Procalcitonin plasma above 0.5μg/L was associated with 16% vs. 19% (p=0.78) risk of death after 7 days.

CONCLUSION

This early experience with SARS-CoV-2 in Spain suggests that a strategy of right oxygenation avoiding non-invasive mechanical ventilation was life-saving. Seven-day mortality in SARS-CoV-2 requiring intubation was lower than 15%, with 80% of patients still requiring mechanical ventilation. After 15 days of ICU admission, half of patients remained intubated, whereas one third died.

Authors+Show Affiliations

Critical Care Department, Hospital Universitario de Alava, Spain.Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto Salud Carlos II, Madrid, Spain; Clinical Research in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research, Barcelona, Spain; Clinical Research, CHU Nîmes, University Montpellier - Nîmes, Nîmes, France.Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto Salud Carlos II, Madrid, Spain; Clinical Research in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research, Barcelona, Spain. Electronic address: stmagraner@gmail.com.Critical Care Department, Hospital Universitario de Alava, Spain.Critical Care Department, Hospital Universitario de Alava, Spain.Critical Care Department, Hospital Universitario de Alava, Spain.Critical Care Department, Hospital Universitario de Alava, Spain.Critical Care Department, Hospital Universitario de Alava, Spain.Critical Care Department, Hospital Universitario de Alava, Spain.Critical Care Department, Hospital Universitario de Alava, Spain.Critical Care Department, Hospital Universitario de Alava, Spain.Critical Care Department, Hospital Universitario de Alava, Spain.Critical Care Department, Hospital Universitario de Alava, Spain.Critical Care Department, Hospital Universitario de Alava, Spain.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32278670

Citation

Barrasa, Helena, et al. "SARS-CoV-2 in Spanish Intensive Care Units: Early Experience With 15-day Survival in Vitoria." Anaesthesia, Critical Care & Pain Medicine, vol. 39, no. 5, 2020, pp. 553-561.
Barrasa H, Rello J, Tejada S, et al. SARS-CoV-2 in Spanish Intensive Care Units: Early experience with 15-day survival in Vitoria. Anaesth Crit Care Pain Med. 2020;39(5):553-561.
Barrasa, H., Rello, J., Tejada, S., Martín, A., Balziskueta, G., Vinuesa, C., Fernández-Miret, B., Villagra, A., Vallejo, A., San Sebastián, A., Cabañes, S., Iribarren, S., Fonseca, F., & Maynar, J. (2020). SARS-CoV-2 in Spanish Intensive Care Units: Early experience with 15-day survival in Vitoria. Anaesthesia, Critical Care & Pain Medicine, 39(5), 553-561. https://doi.org/10.1016/j.accpm.2020.04.001
Barrasa H, et al. SARS-CoV-2 in Spanish Intensive Care Units: Early Experience With 15-day Survival in Vitoria. Anaesth Crit Care Pain Med. 2020;39(5):553-561. PubMed PMID: 32278670.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - SARS-CoV-2 in Spanish Intensive Care Units: Early experience with 15-day survival in Vitoria. AU - Barrasa,Helena, AU - Rello,Jordi, AU - Tejada,Sofia, AU - Martín,Alejandro, AU - Balziskueta,Goiatz, AU - Vinuesa,Cristina, AU - Fernández-Miret,Borja, AU - Villagra,Ana, AU - Vallejo,Ana, AU - San Sebastián,Ana, AU - Cabañes,Sara, AU - Iribarren,Sebastián, AU - Fonseca,Fernando, AU - Maynar,Javier, AU - ,, Y1 - 2020/04/09/ PY - 2020/04/07/received PY - 2020/04/07/accepted PY - 2020/4/13/pubmed PY - 2020/10/24/medline PY - 2020/4/13/entrez KW - ARDS KW - COVID-19 KW - Pneumonia KW - Procalcitonin SP - 553 EP - 561 JF - Anaesthesia, critical care & pain medicine JO - Anaesth Crit Care Pain Med VL - 39 IS - 5 N2 - PURPOSE: Community transmission of SARS-CoV-2 was detected in Spain in February 2020, with 216% intensive care unit (ICU) capacity expanded in Vitoria by March 18th, 2020. METHODS: We identified patients from the two public hospitals in Vitoria who were admitted to ICU with confirmed infection by SARS-CoV-2. Data reported here were available in April 6th, 2020. Mortality was assessed in those who completed 15-days of ICU stay. RESULTS: We identified 48 patients (27 males) with confirmed SARS-CoV-2. Median [interquartile range (IQR)] age of patients was 63 [51-75] years. Symptoms began a median of 7 [5-12] days before ICU admission. The most common comorbidities identified were obesity (48%), arterial hypertension (44%) and chronic lung disease (37%). All patients were admitted by hypoxemic respiratory failure and none received non-invasive mechanical ventilation. Forty-five (94%) underwent intubation, 3 (6%) high flow nasal therapy (HFNT), 1 (2%) extracorporeal membrane oxygenation (ECMO) and 22 (46%) required prone position. After 15 days, 14/45 (31%) intubated patients died (13% within one week), 10/45 (22%) were extubated, and 21/45 (47%) underwent mechanical ventilation. Six patients had documented super-infection. Procalcitonin plasma above 0.5μg/L was associated with 16% vs. 19% (p=0.78) risk of death after 7 days. CONCLUSION: This early experience with SARS-CoV-2 in Spain suggests that a strategy of right oxygenation avoiding non-invasive mechanical ventilation was life-saving. Seven-day mortality in SARS-CoV-2 requiring intubation was lower than 15%, with 80% of patients still requiring mechanical ventilation. After 15 days of ICU admission, half of patients remained intubated, whereas one third died. SN - 2352-5568 UR - https://www.unboundmedicine.com/medline/citation/32278670/SARS_CoV_2_in_Spanish_Intensive_Care_Units:_Early_experience_with_15_day_survival_in_Vitoria_ DB - PRIME DP - Unbound Medicine ER -