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      SARS-Cov-2 in Spanish Intensive Care: Early Experience with 15-day Survival In Vitoria

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          Abstract

          Purpose: Community transmission of SARS-CoV-2 was detected in Spain in February 2020, with 216% intensive care unit (ICU) capacity expanded in Vitoria by March 18 th, 2020.

          Methods: We identified patients from the two public hospitals in Vitoria who were admitted to ICU with confirmed infection by SARS-CoV-2. Data reported here were available in March 31th, 2020. Mortality was assessed in those who completed 7-days of ICU stay.

          Results: We identified 48 patients (27 males) with confirmed SARS-CoV-2. Median [interquartile range (IQR)] age of patients was 63 [51-75] years. Symptoms began a median of 7 [5-12] days before ICU admission. The most common comorbidities identified were obesity ( n = 48%), arterial hypertension ( n = 44%) and chronic lung disease ( n = 37%). All patients were admitted by hypoxemic respiratory failure and none received non-invasive mechanical ventilation. Forty-five (94%) underwent intubation, 3 HFNT, 1 (2%) extracorporeal membrane oxygenation (ECMO) and 22 (49%) required prone position. After 15 days, 14/45 (31%) intubated patients died (13% within one week), 10 (22%) were extubated, and 21/45 (47%) underwent mechanical ventilation. Six patients had documented co-infection. Procalcitonin plasma above 0.5 µg/L was associated with 16% vs. 19% ( p = 0.78) risk of death after 7 days.

          Conclusion: This early experience with SARS-CoV-2 in Spain suggests that a strategy of right oxygenation avoiding non-invasive mechanical ventilation was life-saving. Seven-day mortality in SARS-CoV-2 requiring intubation was lower than 15%, with 80% of patients still requiring mechanical ventilation. After 15 days of ICU admission, half of patients remained intubated, whereas one third died.

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          Contributors
          Journal
          Anaesth Crit Care Pain Med
          Anaesth Crit Care Pain Med
          Anaesthesia, Critical Care & Pain Medicine
          Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS.
          2352-5568
          9 April 2020
          9 April 2020
          Affiliations
          [1 ]Critical Care Department, Hospital Universitario de Alava, Spain
          [2 ]Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto Salud Carlos II, Madrid, Spain
          [3 ]Clinical Research in Pneumonia & Sepsis (CRIPS), Vall d’Hebron Institute of Research, Barcelona, Spain
          [4 ]Clinical Research, CHU Nîmes, University Montpellier - Nîmes, Nîmes, France
          Author notes
          [* ]Corresponding author: Ps. Vall d’Hebron 129. AMI 14, 08035 Barcelona, Spain Jrello@ 123456crips.es
          [#]

          HB and JR contributed equally as first authors.

          Article
          S2352-5568(20)30064-3
          10.1016/j.accpm.2020.04.001
          7144603
          32278670
          00594729-10f1-43bd-9500-b0a480bf9cbb
          © 2020 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

          Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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