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

Abstract

BACKGROUNDCommunity transmission of coronavirus 2019 was detected in the state of Washington in February 2020. METHODSWe 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. RESULTSWe 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. CONCLUSIONSDuring 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.

COVID-19 : caractéristiques cliniques, biologiques et radiologiques chez l’adulte, la femme enceinte et l’enfant. Une mise au point au cœur de la pandémie

“…Soulignons que ces données dépendent probablement des caractéristiques démographiques des populations touchées : en effet, comparativement aux observations chinoises ou italiennes, les premiers cas américains admis en réanimation semblent être plus souvent atteints d'insuffisance cardiaque et d'insuffisance rénale chroniques[40,41].Enfin, un indice de masse corporelle élevé a été rapporté chez 24 patients admis en réanimation à Washington (IMC moyen 32.3, écart-type 7.2), suggérant que le surpoids et l'obésité pouvait être un facteur de risque d'infection sévère à SARS-CoV-2[41].…”

The Renin-Angiotensin-Aldosterone System in Coronavirus Infection—Current Considerations During the Pandemic

“…30 In the initial wave of COVID-19 in Seattle, patients with cardiovascular compromise seldom had superinfection, suggesting that the cardiovascular instability was mostly due to the consequences of viral infection. 6 Furthermore, in this patient cohort, echocardiography also rarely identified ventricular dysfunction, although myocarditis is a possibility in this disease. 30 This latest data from the pandemic in the United States suggests that vasoplegic shock from the effects of the coronavirus is a likely clinical presentation in severe COVID-19.…”

“…30 This latest data from the pandemic in the United States suggests that vasoplegic shock from the effects of the coronavirus is a likely clinical presentation in severe COVID-19. 6 A possible etiology for this low systemic vascular tone in this clinical setting may be the disordered function of the RAAS. 1;21 The first possibility is that patients on ACEI and ARBS may be at greater risk for vasoplegia in the setting of an exaggerated systemic inflammatory response, akin to what we typically observe in perioperative cardiothoracic and vascular practice.…”

Safe bronchodilator treatment in mechanically ventilated COVID-19 patients: A single center experience

“…Dear Editor, Over one million people worldwide have been infected with Coronavirus disease 2019 . Up to 12% of them may require intensive care unit admission and 75% of them may need mechanical ventilation [1,2]. A significant proportion of COVID-19 patients suffer from chronic obstructive lung disease, asthma or other pulmonary disorders, which are associated with an increased risk of severe infection requiring respiratory assistance [3,4].…”