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Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy.
Crit Care Resusc. 2020 Sep; 22(3):200-211.CC

Abstract

OBJECTIVE

Describe characteristics, daily care and outcomes of patients with coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS).

DESIGN

Case series of 73 patients.

SETTING

Large tertiary hospital in Milan.

PARTICIPANTS

Mechanically ventilated patients with confirmed COVID-19 admitted to the intensive care unit (ICU) between 20 February and 2 April 2020.

MAIN OUTCOME MEASURES

Demographic and daily clinical data were collected to identify predictors of early mortality.

RESULTS

Of the 73 patients included in the study, most were male (83.6%), the median age was 61 years (interquartile range [IQR], 54-69 years), and hypertension affected 52.9% of patients. Lymphocytopenia (median, 0.77 x 103 per mm3; IQR, 0.58-1.00 x 103 per mm3), hyperinflammation with C-reactive protein (median, 184.5 mg/dL; IQR, 108.2-269.1 mg/dL) and pro-coagulant status with D-dimer (median, 10.1 μg/m; IQR, 5.0-23.8 μg/m) were present. Median tidal volume was 6.7 mL/kg (IQR, 6.0-7.5 mL/kg), and median positive end-expiratory pressure was 12 cmH2O (IQR, 10-14 cmH2O). In the first 3 days, prone positioning (12-16 h) was used in 63.8% of patients and extracorporeal membrane oxygenation in five patients (6.8%). After a median follow-up of 19.0 days (IQR, 15.0-27.0 days), 17 patients (23.3%) had died, 23 (31.5%) had been discharged from the ICU, and 33 (45.2%) were receiving invasive mechanical ventilation in the ICU. Older age (odds ratio [OR], 1.12; 95% CI, 1.04-1.22; P = 0.004) and hypertension (OR, 6.15; 95% CI, 1.75-29.11; P = 0.009) were associated with mortality, while early improvement in arterial partial pressure of oxygen (PaO2) to fraction of inspired oxygen (FiO2) ratio was associated with being discharged alive from the ICU (P = 0.002 for interaction).

CONCLUSIONS

Despite multiple advanced critical care interventions, COVID-19 ARDS was associated with prolonged ventilation and high short term mortality. Older age and pre-admission hypertension were key mortality risk factors.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04318366.

Authors+Show Affiliations

Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy.Department of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy.Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. landoni.giovanni@hsr.it.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32900326

Citation

Zangrillo, Alberto, et al. "Characteristics, Treatment, Outcomes and Cause of Death of Invasively Ventilated Patients With COVID-19 ARDS in Milan, Italy." Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine, vol. 22, no. 3, 2020, pp. 200-211.
Zangrillo A, Beretta L, Scandroglio AM, et al. Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy. Crit Care Resusc. 2020;22(3):200-211.
Zangrillo, A., Beretta, L., Scandroglio, A. M., Monti, G., Fominskiy, E., Colombo, S., Morselli, F., Belletti, A., Silvani, P., Crivellari, M., Monaco, F., Azzolini, M. L., Reineke, R., Nardelli, P., Sartorelli, M., Votta, C. D., Ruggeri, A., Ciceri, F., De Cobelli, F., ... Landoni, G. (2020). Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy. Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine, 22(3), 200-211.
Zangrillo A, et al. Characteristics, Treatment, Outcomes and Cause of Death of Invasively Ventilated Patients With COVID-19 ARDS in Milan, Italy. Crit Care Resusc. 2020;22(3):200-211. PubMed PMID: 32900326.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy. AU - Zangrillo,Alberto, AU - Beretta,Luigi, AU - Scandroglio,Anna Mara, AU - Monti,Giacomo, AU - Fominskiy,Evgeny, AU - Colombo,Sergio, AU - Morselli,Federica, AU - Belletti,Alessandro, AU - Silvani,Paolo, AU - Crivellari,Martina, AU - Monaco,Fabrizio, AU - Azzolini,Maria Luisa, AU - Reineke,Raffaella, AU - Nardelli,Pasquale, AU - Sartorelli,Marianna, AU - Votta,Carmine D, AU - Ruggeri,Annalisa, AU - Ciceri,Fabio, AU - De Cobelli,Francesco, AU - Tresoldi,Moreno, AU - Dagna,Lorenzo, AU - Rovere-Querini,Patrizia, AU - Serpa Neto,Ary, AU - Bellomo,Rinaldo, AU - Landoni,Giovanni, AU - ,, PY - 2020/9/9/entrez PY - 2020/9/10/pubmed PY - 2020/9/12/medline SP - 200 EP - 211 JF - Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine JO - Crit Care Resusc VL - 22 IS - 3 N2 - OBJECTIVE: Describe characteristics, daily care and outcomes of patients with coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS). DESIGN: Case series of 73 patients. SETTING: Large tertiary hospital in Milan. PARTICIPANTS: Mechanically ventilated patients with confirmed COVID-19 admitted to the intensive care unit (ICU) between 20 February and 2 April 2020. MAIN OUTCOME MEASURES: Demographic and daily clinical data were collected to identify predictors of early mortality. RESULTS: Of the 73 patients included in the study, most were male (83.6%), the median age was 61 years (interquartile range [IQR], 54-69 years), and hypertension affected 52.9% of patients. Lymphocytopenia (median, 0.77 x 103 per mm3; IQR, 0.58-1.00 x 103 per mm3), hyperinflammation with C-reactive protein (median, 184.5 mg/dL; IQR, 108.2-269.1 mg/dL) and pro-coagulant status with D-dimer (median, 10.1 μg/m; IQR, 5.0-23.8 μg/m) were present. Median tidal volume was 6.7 mL/kg (IQR, 6.0-7.5 mL/kg), and median positive end-expiratory pressure was 12 cmH2O (IQR, 10-14 cmH2O). In the first 3 days, prone positioning (12-16 h) was used in 63.8% of patients and extracorporeal membrane oxygenation in five patients (6.8%). After a median follow-up of 19.0 days (IQR, 15.0-27.0 days), 17 patients (23.3%) had died, 23 (31.5%) had been discharged from the ICU, and 33 (45.2%) were receiving invasive mechanical ventilation in the ICU. Older age (odds ratio [OR], 1.12; 95% CI, 1.04-1.22; P = 0.004) and hypertension (OR, 6.15; 95% CI, 1.75-29.11; P = 0.009) were associated with mortality, while early improvement in arterial partial pressure of oxygen (PaO2) to fraction of inspired oxygen (FiO2) ratio was associated with being discharged alive from the ICU (P = 0.002 for interaction). CONCLUSIONS: Despite multiple advanced critical care interventions, COVID-19 ARDS was associated with prolonged ventilation and high short term mortality. Older age and pre-admission hypertension were key mortality risk factors. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04318366. SN - 1441-2772 UR - https://www.unboundmedicine.com/medline/citation/32900326/Characteristics_treatment_outcomes_and_cause_of_death_of_invasively_ventilated_patients_with_COVID_19_ARDS_in_Milan_Italy_ L2 - https://ClinicalTrials.gov/search/term=32900326 [PUBMED-IDS] DB - PRIME DP - Unbound Medicine ER -