Critically ill patients with COVID-19 in Hong Kong: a multicentre retrospective observational cohort study

Ling, Lowell; So, Christina; Shum, Hoi Ping; Chan, Paul K S; Lai, Christopher K C; Kandamby, Darshana H; Ho, Eunise; So, Dominic; Yan, Wing Wa; Lui, Grace; Leung, Wai Shing; Chan, Man Chun; Gomersall, Charles D

Objective To report the first eight cases of critically ill patients with coronavirus disease 2019 (COVID-19) in Hong Kong, describing the treatments and supportive care they received and their 28-day outcomes. Design Multicentre retrospective observational cohort study. Setting Three multidisciplinary intensive care units (ICUs) in Hong Kong. Participants All adult critically ill patients with confirmed COVID-19 admitted to ICUs in Hong Kong between 22 January and 11 February 2020. Main outcome measure 28-day mortality. Results Eight out of 49 patients with COVID-19 (16%) were admitted to Hong Kong ICUs during the study period. The median age was 64.5 years (range, 42–70) with a median admission Sequential Organ Failure Assessment (SOFA) score of 6 (IQR, 4–7). Six patients (75%) required mechanical ventilation, six patients (75%) required vasopressors and two (25%) required renal replacement therapy. None of the patients required prone ventilation, nitric oxide or extracorporeal membrane oxygenation. The median times to shock reversal and extubation were 9 and 11 days respectively. At 28 days, one patient (12%) had died and the remaining seven (88%) all survived to ICU discharge. Only one of the survivors (14%) still required oxygen at 28 days. Conclusion Critically ill patients with COVID-19 often require a moderate duration of mechanical ventilation and vasopressor support. Most of these patients recover and survive to ICU discharge with supportive care using lung protective ventilation strategies, avoiding excess fluids, screening and treating bacterial co-infection, and timely intubation. Lower rather than upper respiratory tract viral burden correlates with clinical severity of illness.