Ling Lowell, So Christina, Shum Hoi Ping, Chan Paul K S, Lai Christopher K C, Kandamby Darshana H, Ho Eunise, So Dominic, Yan Wing Wa, Lui Grace, Leung Wai Shing, Chan Man Chun, Gomersall Charles D
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China.
Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong Kong, China.
Crit Care Resusc. 2020 Apr 6;22(2):119-125. doi: 10.51893/2020.2.oa1.
To report the first eight cases of critically ill patients with coronavirus disease 2019 (COVID-19) in Hong Kong, describing the treatments and supportive care they received and their 28-day outcomes.
Multicentre retrospective observational cohort study.
Three multidisciplinary intensive care units (ICUs) in Hong Kong.
All adult critically ill patients with confirmed COVID-19 admitted to ICUs in Hong Kong between 22 January and 11 February 2020.
28-day mortality.
Eight out of 49 patients with COVID-19 (16%) were admitted to Hong Kong ICUs during the study period. The median age was 64.5 years (range, 42–70) with a median admission Sequential Organ Failure Assessment (SOFA) score of 6 (IQR, 4–7). Six patients (75%) required mechanical ventilation, six patients (75%) required vasopressors and two (25%) required renal replacement therapy. None of the patients required prone ventilation, nitric oxide or extracorporeal membrane oxygenation. The median times to shock reversal and extubation were 9 and 11 days respectively. At 28 days, one patient (12%) had died and the remaining seven (88%) all survived to ICU discharge. Only one of the survivors (14%) still required oxygen at 28 days.
Critically ill patients with COVID-19 often require a moderate duration of mechanical ventilation and vasopressor support. Most of these patients recover and survive to ICU discharge with supportive care using lung protective ventilation strategies, avoiding excess fluids, screening and treating bacterial co-infection, and timely intubation. Lower rather than upper respiratory tract viral burden correlates with clinical severity of illness.
报告香港首批8例2019冠状病毒病（COVID-19）危重症患者，描述他们接受的治疗和支持性护理以及28天的预后情况。
多中心回顾性观察队列研究。
香港的3个多学科重症监护病房（ICU）。
2020年1月22日至2月11日期间在香港ICU确诊为COVID-19的所有成年危重症患者。
28天死亡率。
在研究期间，49例COVID-19患者中有8例（16%）被收入香港ICU。中位年龄为64.5岁（范围42 - 70岁），入院时序贯器官衰竭评估（SOFA）评分中位数为6分（四分位间距，4 - 7）。6例患者（75%）需要机械通气，6例患者（75%）需要血管活性药物支持，2例（25%）需要肾脏替代治疗。所有患者均无需俯卧位通气、一氧化氮或体外膜肺氧合治疗。休克逆转和拔管的中位时间分别为9天和11天。28天时，1例患者（12%）死亡，其余7例（88%）均存活至ICU出院。仅1例幸存者（14%）在28天时仍需吸氧。
COVID-19危重症患者通常需要适度时长的机械通气和血管活性药物支持。这些患者中的大多数通过采用肺保护性通气策略、避免液体过量、筛查和治疗细菌合并感染以及及时插管等支持性护理措施得以康复并存活至ICU出院。下呼吸道而非上呼吸道病毒载量与疾病的临床严重程度相关。
