Tags

Type your tag names separated by a space and hit enter

COVID-19-Associated Critical Illness-Report of the First 300 Patients Admitted to Intensive Care Units at a New York City Medical Center.
J Intensive Care Med. 2020 Oct; 35(10):963-970.JI

Abstract

BACKGROUND

The first confirmed case of novel coronavirus (2019-nCoV) infection in the United States was reported from the state of Washington in January, 2020. By March, 2020, New York City had become the epicenter of the outbreak in the United States.

METHODS

We tracked all patients with confirmed coronavirus-19 (COVID-19) infection admitted to intensive care units (ICU) at Montefiore Medical Center (Bronx, NY). Data were obtained through manual review of electronic medical records. Patients had at least 30 days of follow-up.

RESULTS

Our first 300 ICU patients were admitted March 10 through April 11, 2020. The majority (60.7%) of patients were men. Acute respiratory distress syndrome (ARDS) was documented in 91.7% of patients; 91.3% required mechanical ventilation. Prone positioning was employed in 58% of patients and neuromuscular blockade in 47.8% of mechanically-ventilated patients. Neither intervention was associated with decreased mortality. Vasopressors were required in 77.7% of patients. Acute kidney injury (AKI) was present on admission in 40.7% of patients, and developed subsequently in 36.0%; 50.9% of patients with AKI received renal replacement therapy (RRT). Overall 30-day mortality rate was 52.3%, and 55.8% among patients receiving mechanical ventilation. In univariate analysis, higher mortality rate was associated with increasing age, male sex, hypertension, obesity, smoking, number of comorbidities, AKI on presentation, and need for vasopressor support. A representative multivariable model for 30-day mortality is also presented, containing patient age, gender, body mass index, and AKI at admission. As of May 11, 2020, 2 patients (0.7%) remained hospitalized.

CONCLUSIONS

Mortality in critical illness associated with COVID-19 is high. The majority of patients develop ARDS requiring mechanical ventilation, vasopressor-dependent shock, and AKI. The variation in mortality rates reported to date likely reflects differences in the severity of illness of the evaluated populations.

Authors+Show Affiliations

Division of Critical Care Medicine, Department of Medicine, 2013Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.Division of Critical Care Medicine, Department of Medicine, 2013Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.Division of Critical Care Medicine, Department of Medicine, 2013Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.Department of Epidemiology and Population Health, 2013Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.Division of Critical Care Medicine, Department of Medicine, 2013Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.Department of Obstetrics and Gynecology, 2013Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.Division of Pulmonary Medicine, Department of Medicine, 2013Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.Division of Critical Care Medicine, Department of Medicine, 2013Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32812834

Citation

Chand, Sudham, et al. "COVID-19-Associated Critical Illness-Report of the First 300 Patients Admitted to Intensive Care Units at a New York City Medical Center." Journal of Intensive Care Medicine, vol. 35, no. 10, 2020, pp. 963-970.
Chand S, Kapoor S, Orsi D, et al. COVID-19-Associated Critical Illness-Report of the First 300 Patients Admitted to Intensive Care Units at a New York City Medical Center. J Intensive Care Med. 2020;35(10):963-970.
Chand, S., Kapoor, S., Orsi, D., Fazzari, M. J., Tanner, T. G., Umeh, G. C., Islam, M., & Dicpinigaitis, P. V. (2020). COVID-19-Associated Critical Illness-Report of the First 300 Patients Admitted to Intensive Care Units at a New York City Medical Center. Journal of Intensive Care Medicine, 35(10), 963-970. https://doi.org/10.1177/0885066620946692
Chand S, et al. COVID-19-Associated Critical Illness-Report of the First 300 Patients Admitted to Intensive Care Units at a New York City Medical Center. J Intensive Care Med. 2020;35(10):963-970. PubMed PMID: 32812834.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - COVID-19-Associated Critical Illness-Report of the First 300 Patients Admitted to Intensive Care Units at a New York City Medical Center. AU - Chand,Sudham, AU - Kapoor,Sumit, AU - Orsi,Deborah, AU - Fazzari,Melissa J, AU - Tanner,Tristan G, AU - Umeh,Genevieve C, AU - Islam,Marjan, AU - Dicpinigaitis,Peter V, PY - 2020/8/20/entrez PY - 2020/8/20/pubmed PY - 2020/9/1/medline KW - COVID-19 KW - SARS-CoV-2 KW - acute respiratory distress KW - critical illness KW - novel coronavirus KW - syndrome (ARDS) SP - 963 EP - 970 JF - Journal of intensive care medicine JO - J Intensive Care Med VL - 35 IS - 10 N2 - BACKGROUND: The first confirmed case of novel coronavirus (2019-nCoV) infection in the United States was reported from the state of Washington in January, 2020. By March, 2020, New York City had become the epicenter of the outbreak in the United States. METHODS: We tracked all patients with confirmed coronavirus-19 (COVID-19) infection admitted to intensive care units (ICU) at Montefiore Medical Center (Bronx, NY). Data were obtained through manual review of electronic medical records. Patients had at least 30 days of follow-up. RESULTS: Our first 300 ICU patients were admitted March 10 through April 11, 2020. The majority (60.7%) of patients were men. Acute respiratory distress syndrome (ARDS) was documented in 91.7% of patients; 91.3% required mechanical ventilation. Prone positioning was employed in 58% of patients and neuromuscular blockade in 47.8% of mechanically-ventilated patients. Neither intervention was associated with decreased mortality. Vasopressors were required in 77.7% of patients. Acute kidney injury (AKI) was present on admission in 40.7% of patients, and developed subsequently in 36.0%; 50.9% of patients with AKI received renal replacement therapy (RRT). Overall 30-day mortality rate was 52.3%, and 55.8% among patients receiving mechanical ventilation. In univariate analysis, higher mortality rate was associated with increasing age, male sex, hypertension, obesity, smoking, number of comorbidities, AKI on presentation, and need for vasopressor support. A representative multivariable model for 30-day mortality is also presented, containing patient age, gender, body mass index, and AKI at admission. As of May 11, 2020, 2 patients (0.7%) remained hospitalized. CONCLUSIONS: Mortality in critical illness associated with COVID-19 is high. The majority of patients develop ARDS requiring mechanical ventilation, vasopressor-dependent shock, and AKI. The variation in mortality rates reported to date likely reflects differences in the severity of illness of the evaluated populations. SN - 1525-1489 UR - https://www.unboundmedicine.com/medline/citation/32812834/COVID_19_Associated_Critical_Illness_Report_of_the_First_300_Patients_Admitted_to_Intensive_Care_Units_at_a_New_York_City_Medical_Center_ L2 - https://journals.sagepub.com/doi/10.1177/0885066620946692?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -