Critically ill COVID-19 patients attended by anesthesiologists in northwestern Spain: A multicenter prospective observational study

Abstract

Background and objectives There is limited information on outcome, complications and treatments of critically ill COVID-19 patients requiring admission to an intensive care unit (ICU). The aim of this study is to describe the clinical ICU course, treatments used, complications and outcomes, of critically ill COVID-19 patients admitted in seven ICU in Galicia region during the 2020 March–April pandemic peak. Methods Between March 21 and April 19, 2020, we evaluated critically ill COVID-19 patients admitted to the ICU of Anesthesia of seven hospitals in Galicia, northwestern Spain. Outcome, complications, and treatments were monitored until May 6, 2020, the final date of follow-up. Results A total of 97 critically ill COVID-19 patients were included. During ICU stay, mechanical ventilation became necessary in 80 (82.5%) patients, and tracheostomy in 22 (22.7%) patients. Prone position was used frequently in both intubated (67.5%) and awake (27.8%) patients. Medications consisted of antivirals agents (92.7%), corticosteroids (93.8%), tocilizumab (57.7%), and intermediate or high doses of anticoagulants (83.5%). The most frequent complications were ICU-acquired infection (52.6%), thrombosis events (16.5%), and reintubation (9.3%). After a median follow-up of 42 (34–45) days, 15 patients (15.5%) deceased, 73 patients (75.2%) had been discharged from ICU, and nine patients (9.3%) were still in the ICU. Conclusions A high proportion of our critically ill COVID-19 patients required mechanical ventilation, prone positioning, antiviral medication, corticosteroids, and anticoagulants. ICU complications were frequent, mainly infections and thrombotic events. We had a relatively low mortality of 15,5%.

Factors associated with mortality in patients with COVID‐19 admitted to intensive care: a systematic review and meta‐analysis

“…In total, 6498 abstracts were screened, with 751 full‐text reviews. Fifty‐eight studies with 44,305 patients were included in the review [2, 8‐65]. These included studies provided data on mortality or survival following ICU admission for 43,845 (99.0%) of the patients.…”

Practice of tracheostomy in patients with acute respiratory failure related to COVID–19 – Insights from the PRoVENT–COVID study

“…Practice of tracheostomy is difficult to compare to other cohorts of invasively ventilated COVID–19 patients because of the large variability seen in both incidence and timing in a number of identified studies. Incidence of tracheostomy in invasively ventilated COVID–19 patients has been shown to range from 8 to 77% 4 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , and mean or median timing from 4 to 23 days 6 , 20 , 23 , 25 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 . As many of these identified studies are single center, this may reflect differences in local practices irrespective of national guidelines.…”

Higher versus lower dose corticosteroids for severe to critical COVID-19: A systematic review and dose-response meta-analysis

“…Seven trials randomized patients to corticosteroid with cumulative doses of ≤60 mg dexamethasone equivalent or standard care or placebo, eight trials randomized patients to with cumulative dose of >60 mg dexamethasone equivalent or standard care or placebo, and six trials compared head-to-head corticosteroid doses (4,(40)(41)(42)48). Table 1 presents more details on trial characteristics (3,4,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(51)(52)(53).…”