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Characteristics and Outcomes of COVID-19 Patients with Respiratory Failure Admitted to a "Pandemic Ready" Intensive Care Unit - Lessons from Singapore.
Ann Acad Med Singap. 2020 Jul; 49(7):434-448.AA

Abstract

INTRODUCTION

Singapore was one of the first countries affected by the coronavirus disease 2019 (COVID-19) pandemic but has been able to prevent its healthcare system and intensive care units (ICU) from being overwhelmed. We describe the clinical features, management and outcomes of COVID-19 patients with respiratory failure admitted to our ICU.

MATERIALS AND METHODS

A case series of COVID-19 patients admitted to our ICU for respiratory failure from 7 February, with data censoring at 30 June 2020, was performed from a review of medical records.

RESULTS

Twenty-two COVID-19 patients were admitted to our ICU for respiratory failure. The median age was 54.5 years (IQR 30-45.5), 72.7% were male and had at least one comorbidity. The Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were 2.5 (IQR 1.25-7) and 10 (8.25-12) respectively. Thirteen patients required invasive mechanical ventilation (IMV) and had a median PaO2/FiO2 ratio of 194 mmHg (IQR 173-213) after intubation. The 28-day survival was 100%, with 2 patients demising subsequently. The overall ICU mortality rate was 9.1% at the time of data censoring. In IMV survivors, length of IMV and ICU stay were 11 days (IQR 9-17.75) and 16 days (IQR 12-32) respectively.

CONCLUSION

Low COVID-19 ICU mortality was observed in our "pandemic-ready" ICU. This was achieved by having adequate surge capacity to facilitate early ICU admission and IMV, lung protective ventilation, and slow weaning. Being able to maintain clinical standards and evidence-based practices without having to resort to rationing contributed to better outcomes.

Authors+Show Affiliations

Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33000106

Citation

Chew, Si Yuan, et al. "Characteristics and Outcomes of COVID-19 Patients With Respiratory Failure Admitted to a "Pandemic Ready" Intensive Care Unit - Lessons From Singapore." Annals of the Academy of Medicine, Singapore, vol. 49, no. 7, 2020, pp. 434-448.
Chew SY, Lee YS, Ghimiray D, et al. Characteristics and Outcomes of COVID-19 Patients with Respiratory Failure Admitted to a "Pandemic Ready" Intensive Care Unit - Lessons from Singapore. Ann Acad Med Singap. 2020;49(7):434-448.
Chew, S. Y., Lee, Y. S., Ghimiray, D., Tan, C. K., & Chua, G. S. (2020). Characteristics and Outcomes of COVID-19 Patients with Respiratory Failure Admitted to a "Pandemic Ready" Intensive Care Unit - Lessons from Singapore. Annals of the Academy of Medicine, Singapore, 49(7), 434-448.
Chew SY, et al. Characteristics and Outcomes of COVID-19 Patients With Respiratory Failure Admitted to a "Pandemic Ready" Intensive Care Unit - Lessons From Singapore. Ann Acad Med Singap. 2020;49(7):434-448. PubMed PMID: 33000106.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characteristics and Outcomes of COVID-19 Patients with Respiratory Failure Admitted to a "Pandemic Ready" Intensive Care Unit - Lessons from Singapore. AU - Chew,Si Yuan, AU - Lee,Yee Shay, AU - Ghimiray,Deepak, AU - Tan,Chee Keat, AU - Chua,Gerald Sw, PY - 2020/10/1/entrez PY - 2020/10/2/pubmed PY - 2020/10/9/medline SP - 434 EP - 448 JF - Annals of the Academy of Medicine, Singapore JO - Ann Acad Med Singap VL - 49 IS - 7 N2 - INTRODUCTION: Singapore was one of the first countries affected by the coronavirus disease 2019 (COVID-19) pandemic but has been able to prevent its healthcare system and intensive care units (ICU) from being overwhelmed. We describe the clinical features, management and outcomes of COVID-19 patients with respiratory failure admitted to our ICU. MATERIALS AND METHODS: A case series of COVID-19 patients admitted to our ICU for respiratory failure from 7 February, with data censoring at 30 June 2020, was performed from a review of medical records. RESULTS: Twenty-two COVID-19 patients were admitted to our ICU for respiratory failure. The median age was 54.5 years (IQR 30-45.5), 72.7% were male and had at least one comorbidity. The Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were 2.5 (IQR 1.25-7) and 10 (8.25-12) respectively. Thirteen patients required invasive mechanical ventilation (IMV) and had a median PaO2/FiO2 ratio of 194 mmHg (IQR 173-213) after intubation. The 28-day survival was 100%, with 2 patients demising subsequently. The overall ICU mortality rate was 9.1% at the time of data censoring. In IMV survivors, length of IMV and ICU stay were 11 days (IQR 9-17.75) and 16 days (IQR 12-32) respectively. CONCLUSION: Low COVID-19 ICU mortality was observed in our "pandemic-ready" ICU. This was achieved by having adequate surge capacity to facilitate early ICU admission and IMV, lung protective ventilation, and slow weaning. Being able to maintain clinical standards and evidence-based practices without having to resort to rationing contributed to better outcomes. SN - 0304-4602 UR - https://www.unboundmedicine.com/medline/citation/33000106/Characteristics_and_Outcomes_of_COVID_19_Patients_with_Respiratory_Failure_Admitted_to_a_"Pandemic_Ready"_Intensive_Care_Unit___Lessons_from_Singapore_ L2 - http://www.annals.edu.sg/pdf/49VolNo7Jul2020/V49N7p434.pdf DB - PRIME DP - Unbound Medicine ER -