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      Outcomes of COVID-19 patients intubated after failure of non-invasive ventilation: a multicenter observational study

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          Abstract

          The efficacy of non-invasive ventilation (NIV) in acute respiratory failure secondary to SARS-CoV-2 infection remains controversial. Current literature mainly examined efficacy, safety and potential predictors of NIV failure provided out of the intensive care unit (ICU). On the contrary, the outcomes of ICU patients, intubated after NIV failure, remain to be explored. The aims of the present study are: (1) investigating in-hospital mortality in coronavirus disease 2019 (COVID-19) ICU patients receiving endotracheal intubation after NIV failure and (2) assessing whether the length of NIV application affects patient survival. This observational multicenter study included all consecutive COVID-19 adult patients, admitted into the twenty-five ICUs of the COVID-19 VENETO ICU network (February–April 2020), who underwent endotracheal intubation after NIV failure. Among the 704 patients admitted to ICU during the study period, 280 (40%) presented the inclusion criteria and were enrolled. The median age was 69 [60–76] years; 219 patients (78%) were male. In-hospital mortality was 43%. Only the length of NIV application before ICU admission (OR 2.03 (95% CI 1.06–4.98), p = 0.03) and age (OR 1.18 (95% CI 1.04–1.33), p < 0.01) were identified as independent risk factors of in-hospital mortality; whilst the length of NIV after ICU admission did not affect patient outcome. In-hospital mortality of ICU patients intubated after NIV failure was 43%. Days on NIV before ICU admission and age were assessed to be potential risk factors of greater in-hospital mortality.

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          Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

          Summary Background An ongoing outbreak of pneumonia associated with the severe acute respiratory coronavirus 2 (SARS-CoV-2) started in December, 2019, in Wuhan, China. Information about critically ill patients with SARS-CoV-2 infection is scarce. We aimed to describe the clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia. Methods In this single-centered, retrospective, observational study, we enrolled 52 critically ill adult patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital (Wuhan, China) between late December, 2019, and Jan 26, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between survivors and non-survivors. The primary outcome was 28-day mortality, as of Feb 9, 2020. Secondary outcomes included incidence of SARS-CoV-2-related acute respiratory distress syndrome (ARDS) and the proportion of patients requiring mechanical ventilation. Findings Of 710 patients with SARS-CoV-2 pneumonia, 52 critically ill adult patients were included. The mean age of the 52 patients was 59·7 (SD 13·3) years, 35 (67%) were men, 21 (40%) had chronic illness, 51 (98%) had fever. 32 (61·5%) patients had died at 28 days, and the median duration from admission to the intensive care unit (ICU) to death was 7 (IQR 3–11) days for non-survivors. Compared with survivors, non-survivors were older (64·6 years [11·2] vs 51·9 years [12·9]), more likely to develop ARDS (26 [81%] patients vs 9 [45%] patients), and more likely to receive mechanical ventilation (30 [94%] patients vs 7 [35%] patients), either invasively or non-invasively. Most patients had organ function damage, including 35 (67%) with ARDS, 15 (29%) with acute kidney injury, 12 (23%) with cardiac injury, 15 (29%) with liver dysfunction, and one (2%) with pneumothorax. 37 (71%) patients required mechanical ventilation. Hospital-acquired infection occurred in seven (13·5%) patients. Interpretation The mortality of critically ill patients with SARS-CoV-2 pneumonia is considerable. The survival time of the non-survivors is likely to be within 1–2 weeks after ICU admission. Older patients (>65 years) with comorbidities and ARDS are at increased risk of death. The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced. Funding None.
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            Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy

            In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited.
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              Covid-19 in Critically Ill Patients in the Seattle Region — Case Series

              Abstract Background Community transmission of coronavirus 2019 (Covid-19) was detected in the state of Washington in February 2020. Methods We identified patients from nine Seattle-area hospitals who were admitted to the intensive care unit (ICU) with confirmed infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Clinical data were obtained through review of medical records. The data reported here are those available through March 23, 2020. Each patient had at least 14 days of follow-up. Results We identified 24 patients with confirmed Covid-19. The mean (±SD) age of the patients was 64±18 years, 63% were men, and symptoms began 7±4 days before admission. The most common symptoms were cough and shortness of breath; 50% of patients had fever on admission, and 58% had diabetes mellitus. All the patients were admitted for hypoxemic respiratory failure; 75% (18 patients) needed mechanical ventilation. Most of the patients (17) also had hypotension and needed vasopressors. No patient tested positive for influenza A, influenza B, or other respiratory viruses. Half the patients (12) died between ICU day 1 and day 18, including 4 patients who had a do-not-resuscitate order on admission. Of the 12 surviving patients, 5 were discharged home, 4 were discharged from the ICU but remained in the hospital, and 3 continued to receive mechanical ventilation in the ICU. Conclusions During the first 3 weeks of the Covid-19 outbreak in the Seattle area, the most common reasons for admission to the ICU were hypoxemic respiratory failure leading to mechanical ventilation, hypotension requiring vasopressor treatment, or both. Mortality among these critically ill patients was high. (Funded by the National Institutes of Health.)
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                Author and article information

                Contributors
                pnavalesi@gmail.com
                covid-19venetonetwork@gmail.com
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                6 September 2021
                6 September 2021
                2021
                : 11
                : 17730
                Affiliations
                [1 ]GRID grid.411474.3, ISNI 0000 0004 1760 2630, Institute of Anaesthesia and Intensive Care, , Padua University Hospital, ; Padua, Italy
                [2 ]GRID grid.5608.b, ISNI 0000 0004 1757 3470, Department of Medicine (DIMED), , University of Padua, ; Via Vincenzo Gallucci 13, 35121 Padua, Italy
                [3 ]Emergency Medical Services, Regional Department, AULSS 3, Venice, Italy
                [4 ]GRID grid.5611.3, ISNI 0000 0004 1763 1124, Anaesthesia and Intensive Care Unit B, Department of Surgery, Dentistry, Gynaecology and Pediatrics, , University of Verona, AOUI - University Hospital Integrated Trust, ; Verona, Italy
                [5 ]GRID grid.411474.3, ISNI 0000 0004 1760 2630, Respiratory Pathophysiology Division, Department of Cardio-Thoracic, Vascular Sciences and Public Health, , Padua University Hospital, ; Padua, Italy
                [6 ]GRID grid.15496.3f, IRCCS San Raffaele Institute, , Vita-Salute San Raffaele University, ; Milan, Italy
                [7 ]U.O.C. Istituto di Anestesia e Rianimazione, Padua, Italy
                [8 ]GRID grid.411474.3, ISNI 0000 0004 1760 2630, Azienda Ospedaliera-Università di Padova, ; Padua, PD Italy
                [9 ]U.O.C. Anestesia e Rianimazione, Presidio Ospedaliero “San Martino” (AULSS 1 Dolomiti), Belluno, BL Italy
                [10 ]U.O.C. Anestesia e Rianimazione, Ospedale di Vittorio Veneto (AULSS 2 Marca Trevigiana), Vittorio Veneto, TV Italy
                [11 ]U.O.C. Anestesia e Rianimazione, Ospedale di Conegliano (AULSS 2 Marca Trevigiana), Conegliano, TV Italy
                [12 ]U.O.C. Anestesia e Rianimazione, Ospedale di Montebelluna (AULSS 2 Marca Trevigiana), Montebelluna, TV Italy
                [13 ]U.O.C. Anestesia e Rianimazione, Ospedale di Oderzo (AULSS 2 Marca Trevigiana), Oderzo, TV Italy
                [14 ]GRID grid.413196.8, U.O.C. Anestesia e Rianimazione, Ospedale Ca’ Foncello (AULSS 2 Marca Trevigiana), ; Treviso, Italy
                [15 ]U.O.C. Anestesia, Rianimazione e Terapia Antalgica, Presidio Ospedaliero di Dolo (AULSS 3 Serenissima), Dolo, VE Italy
                [16 ]U.O.C. Anestesia, Rianimazione e Terapia Antalgica, Presidio Ospedaliero di Mirano (AULSS 3 Serenissima), Mirano, VE Italy
                [17 ]U.O.C. Anestesia e Rianimazione, Ospedale SS. Giovanni e Paolo (AULSS 3 Serenissima), Venezia, Italy
                [18 ]GRID grid.459845.1, ISNI 0000 0004 1757 5003, U.O.C. Anestesia e Rianimazione, Ospedale dell’Angelo (AULSS 3 Serenissima), ; Mestre, VE Italy
                [19 ]U.O.C. Anestesia e Rianimazione, Ospedali di San Donà di Piave e Jesolo (AULSS Veneto Orientale), San Donà di Piave, VE Italy
                [20 ]U.O.C. Anestesia e Rianimazione, Ospedale di Cittadella (AULSS 6 Euganea), Cittadella, PD Italy
                [21 ]U.O.C. Anestesia e Rianimazione, Ospedali Riuniti Padova Sud (AULSS 6 Euganea), Monselice, PD Italy
                [22 ]U.O.C. Anestesia e Rianimazione, Ospedali di Rovigo e Trecenta (AULSS 5 Polesana), Rovigo, Italy
                [23 ]U.O.C. Anestesia e Rianimazione, Ospedale Alto Vicentino (AULSS 7 Pedemontana), Santorso, VI Italy
                [24 ]GRID grid.416724.2, U.O.C. Anestesia e Rianimazione, Ospedale San Bassiano (AULSS 7 Pedemontana), ; Bassano del Grappa, VI Italy
                [25 ]U.O.C Anestesia e Rianimazione, Ospedale di Vicenza (AULSS 8 Berica), Vicenza, VI Italy
                [26 ]GRID grid.411475.2, ISNI 0000 0004 1756 948X, U.O. Anestesia e Rianimazione B, Azienda Ospedaliera Universitaria Integrata Verona, ; Verona, VR Italy
                [27 ]GRID grid.411475.2, ISNI 0000 0004 1756 948X, U.O. Anestesia e Rianimazione A, Azienda Ospedaliera Universitaria Integrata Verona, ; Verona, VR Italy
                [28 ]U.O.C Anestesia e Rianimazione, Ospedale Mater Salutis Di Legnago (AULSS 9 Scaligera), Legnago, VR Italy
                [29 ]U.O.C Anestesia e Rianimazione, Ospedale Magalini di Villafranca (AULSS 9 Scaligera), Legnago, VR Italy
                [30 ]Dipartimento di Anestesia, Rianimazione e Terapia Antalgica, IRCCS Sacro Cuore-Don Calabria, Negrar, VR Italy
                [31 ]U.O.S. Terapia Intensiva, Dipartimento di Anestesia, Rianimazione e Terapia Antalgica, IRCCS Sacro Cuore-Don Calabria, Negrar, VR Italy
                [32 ]U.O. Terapia Intensiva, Ospedale P. Pederzoli – Casa di Cura Privata SpA, Peschiera Sul Garda, VR Italy
                [33 ]GRID grid.18887.3e, ISNI 0000000417581884, IRCCS San Raffaele Scientific Institute, ; Milan, MI Italy
                Article
                96762
                10.1038/s41598-021-96762-1
                8421335
                34489504
                1e13df29-92dd-48e1-9e7a-3b5b6c6ffe83
                © The Author(s) 2021

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 6 April 2021
                : 2 August 2021
                Funding
                Funded by: Regione Veneto
                Categories
                Article
                Custom metadata
                © The Author(s) 2021

                Uncategorized
                respiratory distress syndrome,sars-cov-2
                Uncategorized
                respiratory distress syndrome, sars-cov-2

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