Paul Gunchan, Gautam Parshotam Lal, Sharma Shruti, Kumar Jeevan, Gupta Apoorva, Sharma Mukul, Khehra Akashdeep Singh, Paul Birinder S, Mohan Bishav
Department of Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Department of Research & Development, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
J Anaesthesiol Clin Pharmacol. 2022 Jul;38(Suppl 1):S107-S114. doi: 10.4103/joacp.joacp_58_22. Epub 2022 Jun 15.
Many patients with COVID-19 become critically ill and requireICU admission. Risk factors associated with mortality have been studied, but this study provides insight regarding disease progression and hence help to plan rescue strategies to improve patient outcome.
This retrospective, observational study included all patients with diagnosis of COVID-19 from March1 to June30,2021 who died in hospital.
During the study period, 1600 patients were admitted, with 1138 (71%) needing ICU care. There were 346 (21.6%) deaths, distributed as 15.8%(n = 55) within 48h of admission, 46.2%(n = 160) in next 10 days, and 37.8%(n = 131) thereafter. This trimodal mortality pattern of distribution was similar to polytrauma patients. Patients were divided into categories according to time duration from admission to death. In our cohort, 235 (14.7%) patients required mechanical ventilation, with a mortality of 85.4%(n = 201). Tachypnea was significantly (P < 0.001) associated with death at all times; however, hypotension was associated with early death and low oxygen saturation with poor outcome upto 10 days (P < 0.001). Refractory hypoxia was cause of death in all three groups, while other causes in group II were AKI (28%), sepsis (18%), and MODS (10%). Group III patients had different causes of mortality, including barotrauma (9%), pulmonary thromboembolism (8%), refractory hypercarbia (12%), MODS (13%), AKI (10%), sepsis (7%), and cardiac events (6%).
While physiological dearrangements are associated with rapid progression and early death, complications related to hyper-coagulable state, lung injury, and organ failure lead to death later. Providing quality care to a high volume of patients is a challenge for all, but posthoc analysis such as air crash investigation can help find out potential areas of improvement and contribute to better outcomes and mortality reduction.
许多新冠肺炎患者病情危重，需要入住重症监护病房（ICU）。与死亡率相关的危险因素已得到研究，但本研究深入探讨了疾病进展情况，从而有助于制定挽救策略以改善患者预后。
这项回顾性观察性研究纳入了2021年3月1日至6月30日期间在医院死亡的所有确诊新冠肺炎患者。
在研究期间，共收治1600例患者，其中1138例（71%）需要重症监护。死亡346例（21.6%），分布情况如下：入院48小时内死亡15.8%（n = 55），接下来10天内死亡46.2%（n = 160），此后死亡37.8%（n = 131）。这种三峰分布的死亡模式与多发伤患者相似。根据从入院到死亡的时间长短将患者分类。在我们的队列中，235例（14.7%）患者需要机械通气，死亡率为85.4%（n = 201）。呼吸急促在各个时间段均与死亡显著相关（P < 0.001）；然而，低血压与早期死亡相关，低氧饱和度与10天内的不良预后相关（P < 0.001）。难治性低氧是所有三组的死亡原因，而第二组的其他原因包括急性肾损伤（28%）、脓毒症（18%）和多器官功能障碍综合征（10%）。第三组患者有不同的死亡原因，包括气压伤（9%）、肺血栓栓塞（8%）、难治性高碳酸血症（12%）、多器官功能障碍综合征（13%）、急性肾损伤（10%）、脓毒症（7%）和心脏事件（6%）。
虽然生理紊乱与疾病快速进展和早期死亡相关，但与高凝状态、肺损伤和器官衰竭相关的并发症会导致后期死亡。为大量患者提供优质护理对所有人来说都是一项挑战，但事后分析（如空难调查）有助于找出潜在的改进领域，并有助于改善预后和降低死亡率。
