Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study.
Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study.
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DOI：
10.1007/s00134-020-06294-x
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发表时间：
2021-01
影响因子：
38.9
通讯作者：
COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators
中科院分区：
文献类型：
--
作者：
COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators
描述急性呼吸窘迫综合征（ARDS）的严重程度、通气管理和实验室确诊COVID-19的ICU患者的结局，并确定ICU入院后90天死亡率的风险因素。COVID-ICU是一项在法国、比利时和瑞士的138家医院进行的多中心、前瞻性队列研究。收集人口统计学、临床、呼吸支持、连续干预、ICU住院时间和生存数据。2020年2月25日至5月4日，4643例患者（中位[IQR]年龄63 [54-71]岁，SAPS II 37 [28-50]岁）入住ICU，4244例患者的ICU入院后第90天状态可用。在ICU入院时，分别有29%、19%和6%的患者采用标准氧疗、高流量氧疗和无创通气。2635例（63%）患者在前24小时内插管，而总共3376例（80%）患者在ICU住院期间的某个时间点接受有创机械通气（MV）。呼气末正压和平台压的中位数（IQR）分别为12（10-14）cmH 2 O和24（21-27）cmH 2 O。由MV传输到肺的机械功率为26.5（18.6-34.9）J/min。在第-1天，分别对88%和70%的插管患者应用麻痹剂和俯卧位。在这些患者中，分别有207例（9%）和1209例（58%）被诊断为肺栓塞和呼吸机相关性肺炎。第90天，1298/4244例（31%）患者死亡。在ICU入院当天接受有创或无创通气的患者中，90天死亡率随ICU入院时ARDS严重程度的增加而增加（轻度、中度和重度ARDS分别为30%、34%和50%），并在研究期间从42%降至25%。90天死亡率的早期独立预测因素为年龄较大、免疫抑制、重度肥胖、糖尿病、较高的肾脏和心血管SOFA评分组分、较低的PaO 2/FiO 2比值和较短的首次症状与ICU入院之间的时间。在我们的ICU收治的4000多名COVID-19重症患者中，90天死亡率为31%，并在研究期间从42%降至25%。老年、糖尿病、肥胖和严重ARDS患者的死亡率较高。本文的在线版本（10.1007/s 00134 -020-06294-x）包含补充材料，可供授权用户使用。
To describe acute respiratory distress syndrome (ARDS) severity, ventilation management, and the outcomes of ICU patients with laboratory-confirmed COVID-19 and to determine risk factors of 90-day mortality post-ICU admission. COVID-ICU is a multi-center, prospective cohort study conducted in 138 hospitals in France, Belgium, and Switzerland. Demographic, clinical, respiratory support, adjunctive interventions, ICU length-of-stay, and survival data were collected. From February 25 to May 4, 2020, 4643 patients (median [IQR] age 63 [54–71] years and SAPS II 37 [28–50]) were admitted in ICU, with day-90 post-ICU admission status available for 4244. On ICU admission, standard oxygen therapy, high-flow oxygen, and non-invasive ventilation were applied to 29%, 19%, and 6% patients, respectively. 2635 (63%) patients were intubated during the first 24 h whereas overall 3376 (80%) received invasive mechanical ventilation (MV) at one point during their ICU stay. Median (IQR) positive end-expiratory and plateau pressures were 12 (10–14) cmH2O, and 24 (21–27) cmH2O, respectively. The mechanical power transmitted by the MV to the lung was 26.5 (18.6–34.9) J/min. Paralyzing agents and prone position were applied to 88% and 70% of patients intubated at Day-1, respectively. Pulmonary embolism and ventilator-associated pneumonia were diagnosed in 207 (9%) and 1209 (58%) of these patients. On day 90, 1298/4244 (31%) patients had died. Among patients who received invasive or non-invasive ventilation on the day of ICU admission, day-90 mortality increased with the severity of ARDS at ICU admission (30%, 34%, and 50% for mild, moderate, and severe ARDS, respectively) and decreased from 42 to 25% over the study period. Early independent predictors of 90-day mortality were older age, immunosuppression, severe obesity, diabetes, higher renal and cardiovascular SOFA score components, lower PaO2/FiO2 ratio and a shorter time between first symptoms and ICU admission. Among more than 4000 critically ill patients with COVID-19 admitted to our ICUs, 90-day mortality was 31% and decreased from 42 to 25% over the study period. Mortality was higher in older, diabetic, obese and severe ARDS patients. The online version of this article (10.1007/s00134-020-06294-x) contains supplementary material, which is available to authorized users.
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DOI：
10.1136/bmj.b2393
发表时间：
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期刊：
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影响因子：
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DOI：
10.1164/rccm.201804-0692oc
发表时间：
2019-02-01
影响因子：
24.7
作者：
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通讯作者：
Kallet, Richard H.
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：
Serpa Neto, Ary;Deliberato, Rodrigo Octavio;Schultz, Marcus J.
通讯作者：
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