Clinical course and outcomes of ventilated critically ill COVID-19 patients in Selangor state, Malaysia

Abidin, N. H. Z.; Lee, C. K.; Zakaria, S. A.; Ramaiah, Y.; Hilmi, Z. S.; Maule, S. S.

Background: The coronavirus disease 2019 (COVID-19) pandemic has been spreading since December 2019 and still no proven treatment or vaccination has been discovered. Limited case series involving critically ill patients have been reported from South East Asia. Methods: This is a single center, retrospective case series involving 49 ventilated critically ill COVID-19 patients admitted to Hospital Sungai Buloh, Selangor, Malaysia admitted between 7th March until 16th April 2020. Inclusion criteria are COVID-19 adult patients age more than 12 years old, with history of intubation during their intensive care unit (ICU) stay and admitted between 7th March until 16th April. Data were obtained from electronic health record and ICU progress sheet. Results: Forty-nine ventilated COVID-19 patients were included {mean 60.2 [standard deviation (SD): 9.3], range: 42-79, male 75.5%}. Most common comorbidities were hypertension 30 (61%), diabetes 26 (53%) and chronic kidney disease (CKD) 8 (16%). Mean PaO2/FiO2 (PF) ratio on admission was 115 reflecting severe acute respiratory distress syndrome (ARDS). Fourteen (28.6%) patients required prone ventilation. Patients were intubated for an average of 10 (SD: 8.3) days. All patients received antiviral therapies. The more severely ill patients received either corticosteroid [dexamethasone 11 (22.4%), methylprednisolone 12 (24.5%)] or tocilizumab 8 (16.3%). During their illness, 32 (65.3%) patients developed acute kidney injury (AKI) with 23 (46.9%) patients needing renal replacement therapy (RRT). Average ICU stay is 18 (SD: 10.2) days. Thirty-one patients (57%) managed to be extubated and discharged from ICU while 9 (18.3%) succumbed to death. Conclusions: The majority of ventilated critically COVID-19 patients survived their ICU stay but often suffered from multiorgan complications. © Journal of Emergency and Critical Care Medicine. All rights reserved.