Intensive care for seriously ill patients affected by novel coronavirus sars - CoV – 2: Experience of the Crema Hospital, Italy

In this work, the survival and mortality data of 54 consecutive patients admitted to the Intensive Care Unit (ICU) and suffering from severe respiratory insufficiency imputable to viral SARS - CoV - 2 infection were analyzed and shared, after a critical review of the evidence in order to optimize th...

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Bibliographic Details
Published in:The American journal of emergency medicine 2021-07, Vol.45, p.156-161
Main Authors: Zuccon, William, Comassi, Paolo, Adriani, Luca, Bergamaschini, Giulio, Bertin, Elena, Borromeo, Raffaella, Corti, Serena, De Petri, Federica, Dolci, Francesco, Galmozzi, Attilio, Gigliotti, Alberto, Gualdoni, Livio, Guerra, Claudia, Khosthiova, Anna, Leati, Giovanni, Lupi, Giuseppe, Moscato, Paolo, Perotti, Vittorio, Piantelli, Miriam, Ruini, Alain, Sportelli, Silvia, Susca, Micaela, Troiano, Carmine, Benelli, Giampaolo, Buscarini, Elisabetta, Canetta, Ciro, Merli, Guido, Scartabellati, Alessandro, Melilli, B.S.C., Giovanni, Sfogliarini, Roberto, Pellegatta, Germano, Viganò, Giovanni
Format: Article
Language:English
Subjects:
19 outbreak
Adult
Age groups
Aged
Aged, 80 and over
Antibiotics
Anticoagulants
Antiviral agents
Antiviral drugs
Blood
Blood gas analysis
Cardiovascular diseases
Coronary artery disease
Coronaviruses
CoV - 2
Covid
COVID-19
COVID-19 - epidemiology
COVID-19 - therapy
Critical Care - methods
Decision making
Emergency medical care
Emergency medical services
Encephalitis
Female
Heart diseases
Hemorrhage
Heparin
Heterogeneity
Hospitalization - statistics & numerical data
Humans
Hydroxychloroquine
Hypoxia
Infections
Intensive care
Intensive Care Units
Interleukin 6
Intubation
Ischemia
Italy - epidemiology
Lesions
Liver diseases
Lung diseases
Male
Mechanical ventilation
Medical imaging
Men
Middle Aged
Molecular weight
Monoclonal antibodies
Mortality
Ostomy
Outbreaks
Pandemics
Pathology
Patients
Phenotypes
Public health
Radiology
Renal failure
Respiration, Artificial - methods
Retrospective Studies
Sars
SARS-CoV-2
Sepsis
Severe acute respiratory syndrome
Severe acute respiratory syndrome coronavirus 2
Thromboembolism
Ventilation
Ventilators
Womens health
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Summary:In this work, the survival and mortality data of 54 consecutive patients admitted to the Intensive Care Unit (ICU) and suffering from severe respiratory insufficiency imputable to viral SARS - CoV - 2 infection were analyzed and shared, after a critical review of the evidence in order to optimize the most dedicated clinical and treatment strategy, for a future ‘targeted’ management in the care of the possible return flu outbreak. At our Emergency Department of the Crema Hospital, from the beginning of the pandemic until the end of June 2020, 54 consecutive patients admitted to ICU suffering from severe acute respiratory infection (SARI) and severe respiratory distress (ARDS) attributable to viral SARS - CoV - 2 infection were recruited. The recruitment criterion was based on refractory hypoxia, general condition and clinical impairment, comorbidities and CT images. The incoming parameters of the blood chemistry and radiology investigations and the timing of the gold - tracheal intubation were compared. Medical therapy was based on the application of shared protocols. The onset of symptoms was varyng, i.e. within the range of 1–14 days. The average time from the admission to the emergency room to the admission to intensive care was approximately 120 h. The average number of days of hospitalization in the ICU was 28 days. With a majority of male patients, the most significant age group was between 60 and 69 years. There were 21 deaths and, compared to the survivors, the deceased ones were older at an average age of about 67 years (vs an average age of the survivors of about 59 years). From the available data entering the ICU, the surviving patients presented average better values of oximetry and blood gas analysis, with a lower average dosage of D-Dimer than the deceased. Ones with a presence of bilateral pneumonia in all patients, the worsening of the ARDS occurred in 31 patients. 9 out of 25 patients early intubated died, while 12 out of 23 patients died when intubation was performed after 24 h of non-invasive ventilation. The presence of multiple comorbidities was shown in 17 of 28 patients and revealed an additional adverse prognostic factor. Also, more than one complication in the same patient were detected; after respiratory worsening, renal failure was more frequently found in 16 patients. Some particular complications such as lesions induced by ventilation with barotrauma mechanism (VILI), ischemic heart disease and the appearance of central and peri
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2020.08.005