Chronic Critical Illness in Patients with COVID-19: Characteristics and Outcome of Prolonged Intensive Care Therapy.
Chronic Critical Illness in Patients with COVID-19: Characteristics and Outcome of Prolonged Intensive Care Therapy.
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DOI：
10.3390/jcm11041049
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发表时间：
2022-02-17
影响因子：
3.9
通讯作者：
Wichmann D
中科院分区：
文献类型：
--
作者：
Roedl K;Jarczak D;Boenisch O;de Heer G;Burdelski C;Frings D;Sensen B;Nierhaus A;Kluge S;Wichmann D
SARS-CoV-2的传播造成了全球医疗保健威胁。观察到与2019冠状病毒病（COVID-19）呼吸衰竭相关的重症监护住院率较高。医学的进步帮助增加了重症患者的存活人数。然而，有些病人需要长时间的重症监护。关于慢性危重症（CCI）患者预后的数据很少。单中心回顾性研究包括2020年3月1日至2021年8月8日期间在德国汉堡-埃彭多夫大学医学中心重症医学科接受治疗的所有确诊COVID-19成年危重患者。我们在研究期间确定了304例COVID-19危重患者。其中55% （n = 167）患者ICU住院≥21天，定义为慢性危重症，45% （n = 137）患者ICU住院<21天。年龄、性别和身体质量指数在两组之间分布均匀。CCI患者入院时的SAPS II中位数（CCI: 39.5 vs.无CCI: 38分，p = 0.140）和SOFA评分（10 vs. 6, p < 0.001）较高。73% （n = 223）的患者需要有创机械通气（MV） （86% vs. 58%; p < 0.001）。有CCI和无CCI患者的中位MV持续时间分别为30（17-49）天和7（4-12）天（p < 0.001）。回归分析发现ARDS （OR 3.238, 95% CI 1.827 ~ 5.740, p < 0.001）和其他ICU转诊（OR 2.097, 95% CI 1.203 ~ 3.654, p = 0.009）是与新发CCI显著相关的因素。总体而言，我们观察到研究队列中ICU死亡率为38% （n = 115）。在CCI患者中，我们观察到ICU死亡率为28% (n = 46)，而非CCI患者的死亡率为50% (n = 69) （p < 0.001）。90天死亡率分别为28% （n = 46）和50% (n = 70) （p < 0.001）。超过一半的COVID-19危重患者患有CCI。与没有CCI的患者相比，CCI患者的短期和长期生存率较高，当资源允许延长治疗时，不应拒绝延长治疗。
The spread of SARS-CoV-2 caused a worldwide healthcare threat. High critical care admission rates related to Coronavirus Disease 2019 (COVID-19) respiratory failure were observed. Medical advances helped increase the number of patients surviving the acute critical illness. However, some patients require prolonged critical care. Data on the outcome of patients with a chronic critical illness (CCI) are scarce. Single-center retrospective study including all adult critically ill patients with confirmed COVID-19 treated at the Department of Intensive Care Medicine at the University Medical Center Hamburg-Eppendorf, Germany, between 1 March 2020 and 8 August 2021. We identified 304 critically ill patients with COVID-19 during the study period. Of those, 55% (n = 167) had an ICU stay ≥21 days and were defined as chronic critical illness, and 45% (n = 137) had an ICU stay <21 days. Age, sex and BMI were distributed equally between both groups. Patients with CCI had a higher median SAPS II (CCI: 39.5 vs. no-CCI: 38 points, p = 0.140) and SOFA score (10 vs. 6, p < 0.001) on admission. Seventy-three per cent (n = 223) of patients required invasive mechanical ventilation (MV) (86% vs. 58%; p < 0.001). The median duration of MV was 30 (17–49) days and 7 (4–12) days in patients with and without CCI, respectively (p < 0.001). The regression analysis identified ARDS (OR 3.238, 95% CI 1.827–5.740, p < 0.001) and referral from another ICU (OR 2.097, 95% CI 1.203–3.654, p = 0.009) as factors significantly associated with new-onset of CCI. Overall, we observed an ICU mortality of 38% (n = 115) in the study cohort. In patients with CCI we observed an ICU mortality of 28% (n = 46) compared to 50% (n = 69) in patients without CCI (p < 0.001). The 90-day mortality was 28% (n = 46) compared to 50% (n = 70), respectively (p < 0.001). More than half of critically ill patients with COVID-19 suffer from CCI. Short and long-term survival rates in patients with CCI were high compared to patients without CCI, and prolonged therapy should not be withheld when resources permit prolonged therapy.
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影响因子：
3.3
作者：
Maguire JM;Carson SS
通讯作者：
Carson SS
影响因子：
7.1
作者：
Gamberini L;Tonetti T;Spadaro S;Zani G;Mazzoli CA;Capozzi C;Giampalma E;Bacchi Reggiani ML;Bertellini E;Castelli A;Cavalli I;Colombo D;Crimaldi F;Damiani F;Fogagnolo A;Fusari M;Gamberini E;Gordini G;Laici C;Lanza MC;Leo M;Marudi A;Nardi G;Ottaviani I;Papa R;Potalivo A;Russo E;Taddei S;Volta CA;Ranieri VM;ICU-RER COVID-19 Collaboration
通讯作者：
ICU-RER COVID-19 Collaboration
影响因子：
8.8
作者：
Kahn JM;Le T;Angus DC;Cox CE;Hough CL;White DB;Yende S;Carson SS;ProVent Study Group Investigators
通讯作者：
ProVent Study Group Investigators
影响因子：
120.7
作者：
LEGALL, JR;LEMESHOW, S;SAULNIER, F
通讯作者：
SAULNIER, F
影响因子：
38.9
作者：
Bagshaw, Sean M.;Stelfox, Henry T.;Wang, Xioaming
通讯作者：
Wang, Xioaming