Covid-19 in Critically Ill Patients in the Seattle Region — Case Series

By P. Bhatraju, B. Ghassemieh, Michelle Nichols, R. Kim, Keith R. Jerome, A. Nalla, A. Greninger, S. Pipavath, M. Wurfel, Laura Evans and 8 more. New England Journal of Medicine, 2020

2,327 citations recorded by the source corpus.

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.)

Subfields: Infectious Diseases, Neurology

View Paper: https://www.semanticscholar.org/paper/f9c98db5a9b0baec3f441014235860a2326f7880

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In Infectious Diseases

1. J. Levy
2. Miguel A. Hern'an
3. M. J. van der Laan

Citations in the corpus

• Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US. (2020, background): “Length of mechanical ventilatory support, median (IQR), d 11 (7-14) 13 (9-14) 9 (5-13)”
• Severe obesity is associated with higher in-hospital mortality in a cohort of patientswith COVID-19 in the Bronx, New York (2020, neutral): “(2) p-values refer to Chi-square test/ANOVA and stars denote the number of statistically significant pairwise comparisons using Bonferroni's method Abbreviations and symbols: BMI=body mass index, IQR=interquartile range, no.=number, O2=oxygen, ↑=increasing, ARDS=acute respiratory distress syndrome, ”
• Acute kidney injury in patients hospitalized with COVID-19 (2020, neutral): “As had been observed in China and Italy, the disease resulted in a large number of hospitalizations, respiratory failure, and intensive care unit (ICU) admissions.(5,6) The New York metropolitan area began to see a rapid increase in COVID-19 cases in February 2020.”
• Coagulation abnormalities and thrombosis in patients with COVID-19 (2020, background): “1 Many patients with severe COVID-19 present with coagulation abnormalities that mimic other systemic coagulopathies associated with severe infections, such as disseminated intravascular coagulation (DIC) or thrombotic microangiopathy, but COVID-19 has distinct features.”
• COVID-19 antibody seroprevalence in Santa Clara County, California (2020, neutral): “If our estimates of 48,000-81,000 infections represent the cumulative total on April 1, and we project deaths to April 22 (a 3 week lag from time of infection to death 22 ), we estimate about 100 deaths in the county.”
• COVID-19 length of hospital stay: a systematic review and data synthesis (2020, neutral): “However, for 8 studies it was unclear whether the reported LoS included patients who were still hospitalised [33, 34, [36] [37] [38] [39] [40] [41] .”
• Using the Clinical Frailty Scale in Allocating Scarce Health Care Resources (2020, background): “(8,9) In critically ill people with COVID-19, this appears to be substantial for adults aged 65+ years—the risk of death is more than 50% after 28 days.(10) It is important to understand which older adults who are critically ill with COVID-19 disease might withstand both the illness and its treatmen”
• High Prevalence of Obesity in Severe Acute Respiratory Syndrome Coronavirus‐2 (SARS‐CoV‐2) Requiring Invasive Mechanical Ventilation (2020, background): “Surprisingly, body mass index (BMI) was rarely mentioned among the significant clinical risk factors for SARS-CoV-2 reported in early clinical reports from China (2), Italy (3), or the United States (4).”
• Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units. (2020, background): “with completed PICU and hospital admissions (they either died or were discharged), the median (interquartile range) PICU and hospital lengths of stay were 5 (3-9) days and 7 (4-13) days, respectively.”