Covid-19 in Critically Ill Patients in the Seattle Region - Case Series
Covid-19 in Critically Ill Patients in the Seattle Region - Case Series
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DOI：
10.1056/nejmoa2004500
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发表时间：
2020-05-21
影响因子：
158.5
通讯作者：
Mikacenic, Carmen
中科院分区：
文献类型：
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作者：
Bhatraju, Pavan K.;Ghassemieh, Bijan J.;Mikacenic, Carmen
背景2020年2月，华盛顿州检测到2019冠状病毒（COVID-19）的社区传播。方法我们确定了来自西雅图地区9家医院的重症监护室（ICU）确诊感染严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）的患者。通过审查病历获得临床数据。这里报告的数据是截至2020年3月23日的数据。每位患者至少有14天的随访。结果我们确定了24例确诊的新冠肺炎患者。患者的平均（+/- SD）年龄为64 +/- 18岁，63%为男性，症状在入院前7 +/- 4天开始。最常见的症状是咳嗽和呼吸急促; 50%的患者入院时发烧，58%患有糖尿病。所有患者均因低氧性呼吸衰竭入院; 75%（18例患者）需要机械通气。大多数患者（17例）也有低血压，需要血管加压药。无患者的甲型流感、B流感或其他呼吸道病毒检测呈阳性。一半患者（12例）在ICU第1天至第18天死亡，包括4例入院时未接受复苏的患者。在12名存活患者中，5名出院回家，4名从ICU出院但仍留在医院，3名继续在ICU接受机械通气。结论在西雅图地区新冠肺炎爆发的前3周，最常见的入住ICU的原因是低氧血症呼吸衰竭导致机械通气，低血压需要血管加压药治疗，或两者这些重症患者的死亡率很高。（由美国国立卫生研究院资助。临床医生和调查人员报告了来自西雅图地区9家医院的前24名ICU患者。临床表现，治疗和结果的关键方面进行了描述。
Background Community transmission of coronavirus 2019 (Covid-19) was detected in the state of Washington in February 2020.Methods We 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.Results We 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.Conclusions During 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.)Clinicians and investigators report on the first 24 patients admitted to ICUs from nine Seattle area hospitals. Key aspects of the clinical presentation, treatment, and outcomes are described.