Departments of Anesthesia (Yang, Baldry, McMillan), Medicine (Lipes, Dial, Schwartz, Laporta, Warshawsky, Hornstein, de Marchie, Jayaraman) and Surgery (Wong), and Division of Critical Care (Yang, Lipes, Dial, Schwartz, Laporta, Wong, Baldry, Warshawsky, McMillan, Hornstein, de Marchie, Jayaraman), Jewish General Hospital, McGill University, Montréal, Que.
CMAJ Open. 2020 Nov 24;8(4):E788-E795. doi: 10.9778/cmajo.20200159. Print 2020 Oct-Dec.
The coronavirus disease 2019 (COVID-19) pandemic is responsible for millions of infections worldwide, and a substantial number of these patients will be admitted to the intensive care unit (ICU). Our objective was to describe the characteristics, outcomes and management of critically ill patients with COVID-19 pneumonia at a single designated pandemic centre in Montréal, Canada.
A descriptive analysis was performed on consecutive critically ill patients with COVID-19 pneumonia admitted to the ICU at the Jewish General Hospital, a designated pandemic centre in Montréal, between Mar. 5 and May 21, 2020. Complete follow-up data corresponding to death or discharge from hospital health records were included to Aug. 4, 2020. We summarized baseline characteristics, management and outcomes, including mortality.
A total of 106 patients were included in this study. Twenty-one patients (19.8%) died during their hospital stay, and the ICU mortality was 17.0% (18/106); all patients were discharged home or died, except for 4 patients (2 awaiting a rehabilitation bed and 2 awaiting long-term care). Twelve of 65 patients (18.5%) requiring mechanical ventilation died. Prone positioning was used in 29 patients (27.4%), including in 10 patients who were spontaneously breathing; no patient was placed on extracorporeal membrane oxygenation. High-flow nasal cannula was used in 51 patients (48.1%). Acute kidney injury was the most common complication, seen in 20 patients (18.9%), and 12 patients (11.3%) required renal replacement therapy. A total of 53 patients (50.0%) received corticosteroids.
Our cohort of critically ill patients with COVID-19 had lower mortality than that previously described in other jurisdictions. These findings may help guide critical care decision-making in similar health care systems in further COVID-19 surges.
2019 年冠状病毒病（COVID-19）大流行在全球范围内导致了数百万人感染，其中相当一部分患者将被收入重症监护病房（ICU）。我们的目的是描述在加拿大蒙特利尔的一个指定大流行中心的 COVID-19 肺炎重症患者的特征、结局和管理。
对 2020 年 3 月 5 日至 5 月 21 日期间在犹太总医院（一个指定大流行中心）收入 ICU 的连续 COVID-19 肺炎重症患者进行描述性分析。完整的随访数据包括从医院病历中死亡或出院的情况，截至 2020 年 8 月 4 日。我们总结了基线特征、管理和结局，包括死亡率。
本研究共纳入 106 例患者。21 例（19.8%）患者在住院期间死亡，ICU 死亡率为 17.0%（18/106）；所有患者均出院或死亡，除 4 例患者（2 例等待康复床位，2 例等待长期护理）外。65 例需要机械通气的患者中，有 12 例（18.5%）死亡。29 例（27.4%）患者接受俯卧位通气，包括 10 例自主呼吸患者；无患者接受体外膜氧合。51 例（48.1%）患者使用高流量鼻导管。急性肾损伤是最常见的并发症，见于 20 例（18.9%）患者，12 例（11.3%）患者需要肾脏替代治疗。共有 53 例（50.0%）患者接受皮质类固醇治疗。
我们的 COVID-19 重症患者队列的死亡率低于其他司法管辖区先前描述的死亡率。这些发现可能有助于指导在类似医疗保健系统中应对 COVID-19 再次流行时的重症监护决策。
