佛罗里达州中部最大医疗系统中重症 COVID-19 患者的 ICU 结局和生存率。
ICU outcomes and survival in patients with severe COVID-19 in the largest health care system in central Florida.
机构信息
Division of Critical Care - AdventHealth Medical Group, AdventHealth Orlando, Orlando, Florida, United States of America.
Internal Medicine Residency Program, AdventHealth Orlando, Orlando, Florida, United States of America.
出版信息
PLoS One. 2021 Mar 25;16(3):e0249038. doi: 10.1371/journal.pone.0249038. eCollection 2021.
BACKGROUND
Observational studies have consistently described poor clinical outcomes and increased ICU mortality in patients with severe coronavirus disease 2019 (COVID-19) who require mechanical ventilation (MV). Our study describes the clinical characteristics and outcomes of patients with severe COVID-19 admitted to ICU in the largest health care system in the state of Florida, United States.
METHODS
Retrospective cohort study of patients admitted to ICU due to severe COVID-19 in AdventHealth health system in Orlando, Florida from March 11th until May 18th, 2020. Patients were characterized based on demographics, baseline comorbidities, severity of illness, medical management including experimental therapies, laboratory markers and ventilator parameters. Major clinical outcomes analyzed at the end of the study period were: hospital and ICU length of stay, MV-related mortality and overall hospital mortality of ICU patients.
RESULTS
Out of total of 1283 patients with COVID-19, 131 (10.2%) met criteria for ICU admission (median age: 61 years [interquartile range (IQR), 49.5-71.5]; 35.1% female). Common comorbidities were hypertension (84; 64.1%), and diabetes (54; 41.2%). Of the 131 ICU patients, 109 (83.2%) required MV and 9 (6.9%) received ECMO. Lower positive end expiratory pressure (PEEP) were observed in survivors [9.2 (7.7-10.4)] vs non-survivors [10 (9.1-12.9] p = 0.004]. Compared to non-survivors, survivors had a longer MV length of stay (LOS) [14 (IQR 8-22) vs 8.5 (IQR 5-10.8) p< 0.001], Hospital LOS [21 (IQR 13-31) vs 10 (7-1) p< 0.001] and ICU LOS [14 (IQR 7-24) vs 9.5 (IQR 6-11), p < 0.001]. The overall hospital mortality and MV-related mortality were 19.8% and 23.8% respectively. After exclusion of hospitalized patients, the hospital and MV-related mortality rates were 21.6% and 26.5% respectively.
CONCLUSIONS
Our study demonstrates an important improvement in mortality of patients with severe COVID-19 who required ICU admission and MV in comparison to previous observational reports and emphasizes the importance of standard of care measures in the management of COVID-19.
背景
观察性研究一致描述了患有严重 2019 年冠状病毒病（COVID-19）并需要机械通气（MV）的患者的临床结局较差和 ICU 死亡率增加。我们的研究描述了在美国佛罗里达州最大的医疗保健系统中因严重 COVID-19 而入住 ICU 的患者的临床特征和结局。
方法
这是一项回顾性队列研究，研究对象为 2020 年 3 月 11 日至 5 月 18 日期间因严重 COVID-19 入住佛罗里达州奥兰多 AdventHealth 卫生系统 ICU 的患者。根据人口统计学、基线合并症、疾病严重程度、包括实验性治疗在内的医疗管理、实验室标志物和呼吸机参数对患者进行特征描述。在研究结束时分析了主要临床结局：医院和 ICU 住院时间、MV 相关死亡率和 ICU 患者的总体医院死亡率。
结果
在总共 1283 例 COVID-19 患者中，有 131 例（10.2%）符合 ICU 入住标准（中位年龄：61 岁[四分位距（IQR），49.5-71.5]；35.1%为女性）。常见的合并症包括高血压（84 例；64.1%）和糖尿病（54 例；41.2%）。在 131 例 ICU 患者中，109 例（83.2%）需要 MV，9 例（6.9%）接受 ECMO。与非幸存者相比，幸存者的呼气末正压（PEEP）较低[9.2（7.7-10.4）]vs 非幸存者 [10（9.1-12.9] p = 0.004]。与非幸存者相比，幸存者的 MV 持续时间（LOS）更长[14（IQR 8-22）vs 8.5（IQR 5-10.8）p < 0.001]、医院 LOS 更长[21（IQR 13-31）vs 10（7-1）p < 0.001]和 ICU LOS 更长[14（IQR 7-24）vs 9.5（IQR 6-11），p < 0.001]。总体医院死亡率和 MV 相关死亡率分别为 19.8%和 23.8%。排除住院患者后，医院和 MV 相关死亡率分别为 21.6%和 26.5%。
结论
与之前的观察性报告相比，我们的研究表明需要 ICU 入院和 MV 的严重 COVID-19 患者的死亡率有了显著提高，这强调了在 COVID-19 管理中标准治疗措施的重要性。
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