COVID-19 in critical care: epidemiology of the first epidemic wave across England, Wales and Northern Ireland
- PDF / 1,384,576 Bytes
- 13 Pages / 595.276 x 790.866 pts Page_size
- 13 Downloads / 190 Views
ORIGINAL
COVID‑19 in critical care: epidemiology of the first epidemic wave across England, Wales and Northern Ireland Alvin Richards‑Belle1 , Izabella Orzechowska1 , Doug W. Gould1 , Karen Thomas1 , James C. Doidge1 , Paul R. Mouncey1 , Michael D. Christian2 , Manu Shankar‑Hari3 , David A. Harrison1 and Kathryn M. Rowan1* on behalf of the ICNARC COVID-19 Team © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Abstract Purpose: To describe critical care patients with COVID-19 across England, Wales and Northern Ireland and compare them with a historic cohort of patients with other viral pneumonias (non-COVID-19) and with international cohorts of COVID-19. Methods: Extracted data on patient characteristics, acute illness severity, organ support and outcomes from the Case Mix Programme, the national clinical audit for adult critical care, for a prospective cohort of patients with COVID-19 (February to August 2020) are compared with a recent retrospective cohort of patients with other viral pneumonias (non-COVID-19) (2017–2019) and with other international cohorts of critical care patients with COVID-19, the latter identified from published reports. Results: 10,834 patients with COVID-19 (70.1% male, median age 60 years, 32.6% non-white ethnicity, 39.4% obese, 8.2% at least one serious comorbidity) were admitted across 289 critical care units. Of these, 36.9% had a P aO2/FiO2 ratio of ≤ 13.3 kPa (≤ 100 mmHg) consistent with severe ARDS and 72% received invasive ventilation. Acute hospital mortality was 42%, higher than for 5782 critical care patients with other viral pneumonias (non-COVID-19) (24.7%), and most COVID-19 deaths (88.7%) occurred before 30 days. Meaningful international comparisons were limited due to lack of standardised reporting. Conclusion: Critical care patients with COVID-19 were disproportionately non-white, from more deprived areas and more likely to be male and obese. Conventional severity scoring appeared not to adequately reflect their acute sever‑ ity, with the distribution across PaO2/FiO2 ratio categories indicating acutely severe respiratory disease. Critical care patients with COVID-19 experience high mortality and place a great burden on critical care services. Keywords: COVID-19, Coronavirus, Critical care, Pandemic, Outcomes
*Correspondence: [email protected] 1 Intensive Care National Audit and Research Centre (ICNARC), Napier House, 24 High Holborn, London WC1V 6AZ, UK Full author information is available at the end of the article Alvin Richards-Belle and Izabella Orzechowska are joint first authors. ICNARC COVID-19 Team Group members are listed in the Acknowledgements section.
Introduction Since originating in late 2019, in Wuhan China, severe acute respiratory syndrome coronavirus 2, the virus associated with coronavirus disease 2019 (COVID-19), has rapidly spread across the world [1]. As of 16 September 2020, almost 30 million cases were reported, associated with approaching one million deaths [2], including 41,664 in the United Kingdom (UK), r
Data Loading...
