French multicentre observational study on SARS-CoV-2 infections intensive care initial management: the FRENCH CORONA study

Roger, Claire; Collange, Olivier; Mezzarobba, Myriam; Abou-Arab, Osama; Teule, Lauranne; Garnier, Marc; Hoffmann, Clément; Muller, Laurent; Lefrant, Jean-Yves; Guinot, Pierre Grégoire; Novy, Emmanuel; Abraham, Paul; Clavier, Thomas; Bourenne, Jérémy; Besch, Guillaume; Favier, Laurent; Fiani, Michel; Ouattara, Alexandre; Joannes-Boyau, Olivier; Fischer, Marc-Olivier; Leone, Marc; Ait Tamlihat, Younes; Pottecher, Julien; Cordier, Pierre-Yves; Aussant, Philippe; Moussa, Mouhamed Djahoum; Hautin, Etienne; Bouex, Marine; Julia, Jean-Michel; Cady, Julien; Danguy Des Déserts, Marc; Mayeur, Nicolas; Mura, Thibault; Allaouchiche, Bernard

AIM: Describing acute respiratory distress syndrome patterns, therapeutics management, and outcomes of ICU COVID-19 patients and indentifying risk factors of 28-day mortality. METHODS: Prospective multicentre, cohort study conducted in 29 French ICUs. Baseline characteristics, comorbidities, adjunctive therapies, ventilatory support at ICU admission and survival data were collected. RESULTS: From March to July 2020, 966 patients were enrolled with a median age of 66 (interquartile range 58–73) years and a median SAPS II of 37 (29–48). During the first 24 h of ICU admission, COVID-19 patients received one of the following respiratory supports: mechanical ventilation for 559 (58%), standard oxygen therapy for 228 (24%) and high-flow nasal cannula (HFNC) for 179 (19%) patients. Overall, 721 (75%) patients were mechanically ventilated during their ICU stay. Prone positioning and neuromuscular blocking agents were used in 494 (51%) and 460 (48%) patients, respectively. Bacterial co-infections and ventilator-associated pneumonia were diagnosed in 79 (3%) and 411 (43%) patients, respectively. The overall 28-day mortality was 18%. Age, pre-existing comorbidities, severity of respiratory failure and the absence of antiviral therapy on admission were identified as independent predictors of 28-day outcome. CONCLUSION: Severity of hypoxaemia on admission, older age (> 70 years), cardiovascular and renal comorbidities were associated with worse outcome in COVID-19 patients. Antiviral treatment on admission was identified as a protective factor for 28-day mortality. Ascertaining the outcomes of critically ill COVID-19 patients is crucial to optimise hospital and ICU resources and provide the appropriate intensity level of care.