Practice of diagnosis and management of acute respiratory distress syndrome in mainland China: a cross-sectional study

Liu, Ling; Yang, Yi; Gao, Zhiwei; Li, Maoqin; Mu, Xinwei; Ma, Xiaochun; Li, Guicheng; Sun, Wenyue; Wang, Xue; Gu, Qin; Zheng, Ruiqiang; Zhao, Hongsheng; Ao, Dan; Yu, Wenkui; Wang, Yushan; Chen, Kang; Yan, Jie; Li, Jianguo; Cai, Guolong; Wang, Yurong; Wang, Hongliang; Kang, Yan; Slutsky, Arthur S.; Liu, Songqiao; Xie, Jianfen; Qiu, Haibo

doi:10.21037/jtd.2018.08.137

Cited by 31 publications

(27 citation statements)

References 32 publications

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“…These findings are in agreement or similar to the output of our study. However, from our data, 22 of 79 (36.7%) patients with severe ARDS received prone position ventilation, which was much higher than the 8.7% reported in a cross-sectional survey of ARDS in mainland China in 2018 which did not involve COVID-19 patients [21]. This is a small sign that manifests the differentiation in treating patients in an ICU for a general situation versus the ongoing pandemic.…”

Section: Discussioncontrasting

confidence: 61%

Patients with COVID-19 in 19 ICUs in Wuhan, China: a cross-sectional study

et al. 2020

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Background: A COVID-19 outbreak started in Wuhan, China, last December and now has become a global pandemic. The clinical information in caring of critically ill patients with COVID-19 needs to be shared timely, especially under the situations that there is still a largely ongoing spread of COVID-19 in many countries. Methods: A multicenter prospective observational study investigated all the COVID-19 patients received in 19 ICUs of 16 hospitals in Wuhan, China, over 24 h between 8 AM February 2h and 8 AM February 27, 2020. The demographic information, clinical characteristics, vital signs, complications, laboratory values, and clinical managements of the patients were studied.Results: A total of 226 patients were included. Their median (interquartile range, IQR) age was 64 (57-70) years, and 139 (61.5%) patients were male. The duration from the date of ICU admission to the study date was 11 (5-17) days, and the duration from onset of symptoms to the study date was 31 (24-36) days. Among all the patients, 155 (68.6%) had at least one coexisting disease, and their sequential organ failure assessment score was 4 (2-8). Organ function damages were found in most of the patients: ARDS in 161 (71.2%) patients, septic shock in 34 (15.0%) patients, acute kidney injury occurred in 57 (25.2%) patients, cardiac injury in 61 (27.0%) patients, and lymphocytopenia in 160 (70.8%) patients. Of all the studied patients, 85 (37.6%) received invasive mechanical ventilation, including 14 (6.2%) treated with extracorporeal membrane oxygenation (ECMO) at the same time, 20 (8.8%) received noninvasive mechanical ventilation, and 24 (10.6%) received continuous renal replacement therapy. By April 9, 2020, 87 (38.5%) patients were deceased and 15 (6.7%) were still in the hospital.(Continued on next page)

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Section: Discussioncontrasting

confidence: 61%

Patients with COVID-19 in 19 ICUs in Wuhan, China: a cross-sectional study

et al. 2020

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“…2). With all these measurements, although the rate of critically ill patients in Jiangsu had reached 10%, the IMV rate of Jiangsu was kept under 1%, which was significantly lower than our previous survey about ARDS patients [12].…”

Section: (1) Early Recognition Of High-risk and Critically Ill Patientscontrasting

confidence: 64%

Lower mortality of COVID-19 by early recognition and intervention: experience from Jiangsu Province

Sun

Qiu

Huang

et al. 2020

Ann. Intensive Care

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377

347

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“…14 The lower occurrence of barotrauma in our cohort is probably related to the widely accepted strategy of protective ventilation in mainland China. 24 At the same time, prone position and ECMO have been used to treat patients with SARS-CoV-2 pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

Yang

Yuan

et al. 2020

The Lancet Respiratory Medicine

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Background An ongoing outbreak of pneumonia associated with the severe acute respiratory coronavirus 2 (SARS-CoV-2) started in December, 2019, in Wuhan, China. Information about critically ill patients with SARS-CoV-2 infection is scarce. We aimed to describe the clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia.Methods In this single-centered, retrospective, observational study, we enrolled 52 critically ill adult patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital (Wuhan, China) between late December, 2019, and Jan 26, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between survivors and non-survivors. The primary outcome was 28-day mortality, as of Feb 9, 2020. Secondary outcomes included incidence of SARS-CoV-2related acute respiratory distress syndrome (ARDS) and the proportion of patients requiring mechanical ventilation.Findings Of 710 patients with SARS-CoV-2 pneumonia, 52 critically ill adult patients were included. The mean age of the 52 patients was 59·7 (SD 13·3) years, 35 (67%) were men, 21 (40%) had chronic illness, 51 (98%) had fever. (61·5%) patients had died at 28 days, and the median duration from admission to the intensive care unit (ICU) to death was 7 (IQR 3-11) days for non-survivors. Compared with survivors, non-survivors were older (64·6 years [11·2] vs 51·9 years [12·9]), more likely to develop ARDS (26 [81%] patients vs 9 [45%] patients), and more likely to receive mechanical ventilation (30 [94%] patients vs 7 [35%] patients), either invasively or non-invasively. Most patients had organ function damage, including 35 (67%) with ARDS, 15 (29%) with acute kidney injury, 12 (23%) with cardiac injury, 15 (29%) with liver dysfunction, and one (2%) with pneumothorax. 37 (71%) patients required mechanical ventilation. Hospital-acquired infection occurred in seven (13·5%) patients.Interpretation The mortality of critically ill patients with SARS-CoV-2 pneumonia is considerable. The survival time of the non-survivors is likely to be within 1-2 weeks after ICU admission. Older patients (>65 years) with comorbidities and ARDS are at increased risk of death. The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced.Funding None. Articles 2www.thelancet.com/respiratory Published online February 21, 2020 https://doi.

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Practice of diagnosis and management of acute respiratory distress syndrome in mainland China: a cross-sectional study

Cited by 31 publications

References 32 publications

Patients with COVID-19 in 19 ICUs in Wuhan, China: a cross-sectional study

Patients with COVID-19 in 19 ICUs in Wuhan, China: a cross-sectional study

Lower mortality of COVID-19 by early recognition and intervention: experience from Jiangsu Province

Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

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