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COVID-19 in Critically Ill Patients in the Seattle Region — Case Series

Our take —

Among critically-ill patients in the United States, there is a high in-hospital mortality rate. Severely ill patients with acute respiratory failure frequently required prolonged mechanical ventilation with high driving pressures. Further analyses with more patients are needed to fully elucidate these trends.

Study design

Case Series

Study population and setting

24 patients (mean age 64 years; 63% male) with laboratory-confirmed SARS-CoV-2 infection without known travel-related exposure admitted to the ICUs of nine Seattle hospitals from February 24, 2020-March 9, 2020. Patients were followed for at least 14 days.

Summary of Main Findings

Mean duration of symptoms before admission was 7 days. Only 50% presented with measured fever. All patients were admitted for hypoxemic respiratory failure and 75% required mechanical ventilation, often with high plateau and driving pressures. At the time of publication, 50% of patients had died, 30% remained in the hospital (13% receiving mechanical ventilation), and 21% had been discharged.

Study Strengths

Provides detailed description of clinical course in a U.S healthcare setting, including laboratory findings, comorbid conditions, radiographic features, and ventilator parameters.

Limitations

Small number of patients; excluded those <18 years of age. Limited to critically ill patients with COVID-19 who presented to the hospital.

Value added

This study provides details relevant for providers caring for critically-ill COVID-19 patients in a high-resource setting with available ventilators. It also provides further data on the clinical course and mortality of critically-ill patients in the United States.