Critical Care for Severe COVID-19: A Population-based Study from a Province with Low Case-fatality Rate in China

Liao, Xuelian; Chen, Hong; Wang, Bo; Jin, Xiaodong; Li, Zhen; Zhang, Zhongwei; Li, Weimin; Tang, Jin; Wang, Jian; Shi, Rui; Zhen, Xiangde; Wang, Maojuan; Lei, Xianying; Gong, Yu; Lv, Sheng; Jia, Chao; Chen, Li; Shang, Juan; Yang, Min; Wei, Hailong; Zhang, Yuanjun; Yang, Xiong; Shen, Huaqiang; Xiao, Xianhua; Yang, Jie; Wu, Qin; Wang, Wen; Yang, Jin; Liu, Chang; Yin, Wanhong; Xie, Xiaoqi; Tian, Yongming; Liu, Huan; Shuai, Bingxing; Zhang, Wei; Song, Xiangrong; Kang, Yan

Background Data regarding critical care for patients with severe COVID-19 are limited. We aimed to describe and analyse the clinical course, multi-strategy management, and respiratory support usage for the severe COVID-19 at the provincial level. Methods Using data from Sichuan Provincial Department of Health and the population-based multicentre cohort study, all microbiologically confirmed COVID-19 patients in Sichuan who met the national severe criteria were included from January 16 to March 15, 2020. All patients were followed-up from the day of inclusion, noted as Day one (D1), until discharge, death, or the end of the study. Findings Out of 539 COVID-19 patients, 81 severe cases (15.0%) were identified. The median (IQR) age was 50 (39-65) years, 37% were female, and 53.1% had chronic comorbidities. All severe cases were identified before requiring mechanical ventilation. Among the five predefined criteria for severe illness, low PaO2:FiO2 ratio (<300 mmHg) was the most commonly reported, accounting for 87.7% of the severe diagnosed. By establishing provisional ICUs, all 81 patients were admitted to hospitals capable of providing critical care, among whom 51 (63.0%) were treated in provisional ICUs. On D1, 77 patients (95.1%) were admitted, 76 (93.8%) were administered by respiratory support, including 51 (67.9%) by conventional oxygen therapy (COT). By D28, 53 (65.4%) were discharged, three (3.7%) were deceased, and 25 (30.9%) were still hospitalized. COT, administered to 95.1% of the patients, was the most commonly used respiratory support and met 62.7% of the respiratory support needed, followed by high-flow nasal cannula (19.5%) and non-invasive mechanical ventilation (10%). Interpretation The multi-strategy management for severe COVID-19 patients included early identification and timely critical care, including appropriate respiratory support in particular. Preparation of sufficient conventional oxygen equipment should be prioritized.