After the novel coronavirus disease (COVID-19), was declared a pandemic, New York quickly became the new epicenter of the disease. This study was conducted during the peak of COVID-19 in Queens. Many COVID-19 patients with severe acute respiratory distress syndrome (ARDS) required endotracheal intubation and heavy sedation for prolonged periods of time. Unplanned extubation (UE) events have a notable impact on clinical course and outcome. [1] Self-extubation (SE) is the most common reason for UE, and inadequate sedation is one of its most significant risk factors. [1,2] This study examines factors associated with SE events in patients with ARDS in COVID-19. METHODS: At a single acute tertiary care hospital located in Queens, New York, all patients with SARS-CoV-2 infection admitted between March 15, 2020 and April 15, 2020, were screened. Active COVID-19 status was confirmed with reverse transcriptase-polymerase chain reaction assay performed on nasopharyngeal samples. All patients who underwent endotracheal intubation were included in the study. All data were collected from the electronic health record for 28-day outcomes. All UE events, including SE and other causes for UE, number and dosages of sedatives at the time of SE, adverse events, such as cardiac arrest and anoxic brain injury following UE, were examined.
Infection with the SARS-CoV-2 virus results in a wide spectrum of disease, ranging from a mild, self-limited condition to severe illness necessitating intensive care and an increase in mortality. This study highlights the demographic factors and clinical features of adult patients with confirmed Covid-19 hospitalized in an intensive care unit over a two week period in Queens, NY at the initial peak of the pandemic.
METHODS:A retrospective review of the electronic health records (Sunrise, Allscripts Gateway) was performed and data was recorded and analyzed through Research Electronic Data Capture (REDCap). Data on patient demographics, presence of comorbid conditions, presenting symptoms, initial laboratory test values and peak laboratory test values were recorded.RESULTS: 150 patients (17%) patients who were admitted required ICU admission. The median age was 61 years (range 20-95 years). A total of 94 patients were male (62.6%) compared to 56 females (37.3%). Hypertension was the most common comorbidity, affecting 51% of patients, followed by hypercholesterolemia in 41.3%, and, diabetes mellitus in 35.3% patients. Of patients requiring ICU admission, 92.6% required endotracheal intubation and mechanical ventilation. 37.3% underwent proning. The median PEEP applied was 15 cm H2O (5-32 cm H2O) and the median tidal volume was 500 mL (range of 350-630 mL). 6% patients developed pneumothorax, and 4.6% patients developed pneumomediastinum. 81.3% patients developed shock requiring pressors. 40% admitted to the ICU had a cardiac arrest. In terms of mortality, 64.7% patients died after admission to the ICU. 9.3% patients were transitioned to comfort care, and 14.6% underwent tracheostomy for prolonged mechanical ventilation.
CONCLUSIONS:As Queens was at the center of the pandemic and had the largest number of cases by the end of April 2020, this study highlights the clinical presentation and outcomes of critically ill COVID-19 patients at the peak of the pandemic in Queens, NY; the most diverse county in the USA. The predominance of males, the high percentage of those requiring intubation, along with notable complications of lung fibrosis, and high mortality are notable for discussion.CLINICAL IMPLICATIONS: This study provides an insight into the presentation of critically ill COVID 19 patients in a diverse population along with associated complications.
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