Clinical Course of 195 Critically ILL COVID-19 Patients, A Retrospective Multi-Center Study.

Zhou, Shuliang; Yang, Yadong; Zhang, Xingguo; Li, Zhifeng; Liu, Xing; Hu, Chang; Chen, Chunxi; Wang, Dawei; Peng, Zhiyong

INTRODUCTION Coronavirus disease-2019 (COVID-19) outbreak has spread around the world. However, the dynamic course of critically ill COVID-19 has not been described thoroughly. MATERIALS AND METHODS We retrospectively analyzed 195 critically ill COVID-19 patients in Hubei province, China, between January 5, 2020 and April 3, 2020. Epidemiologic data, clinical features, treatments and outcomes were collected and analyzed. RESULTS Most critically ill patients were older with higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. After critical illness onset, a total of 181 (92.8%) patients received ventilation support, of which 84 (43.1%) received non-invasive and 97 (49.7%) received invasive mechanic ventilation (IMV). Among the 97 patients with IMV, 28 (28.9%) received prone ventilation, 57 (58.8%) received neuromuscular blocked therapy and 22 (11.3%) received tracheostomy due to prolonged ventilator use. Early hypoxemia, subsequent hypercapnia, pulmonary hypertension, and finally pulmonary fibrosis were notable in the clinical course of acute respiratory distress syndrome (ARDS). Eighty-nine (45.6%) patients presented with shock. Acute kidney injury (29.7%) and secondary infection (28.2%) were also notable. The overall mortality of critically ill patients at day 28 was 42.1%. ICU mortality was around 33%, as 16 patients died prior to ICU admission. A low PaO2/FiO2 ratio was an independent risk factor for death. High viral load was observed in most non-survivors. CONCLUSION ARDS and shock were notable in the critical illness of COVID-19. Ventilation support and hemodynamic support were the cornerstones for critical care. High viral load was associated with death of critically ill COVID-19 patients.