Critical Illness in Patients With COVID-19: Mounting an Effective Clinical and Research Response | Critical Care Medicine | JAMA | JAMA Network
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Editorial
April 6, 2020

Critical Illness in Patients With COVID-19: Mounting an Effective Clinical and Research Response

Author Affiliations
  • 1Medicine (Critical Care), Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
  • 2St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
  • 3Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
JAMA. 2020;323(16):1559-1560. doi:10.1001/jama.2020.5775

Dedicated, impassioned, and exhausted clinicians the world over are collaborating to report the emerging profile of the coronavirus disease 2019 (COVID-19) pandemic. The unparalleled need for intensive care during this period challenges clinicians to bring their best efforts to the bedside, while advising health care leaders on the optimal management of resources to deliver that care in each jurisdiction. A renewed sense of community is avowed among critical care clinicians who share their early observations through traditional and social media, such that learnings from one group of patients can inform the care of the next.

The multicenter report by Grasselli and colleagues in JAMA provides sobering evidence about the burden of critical illness associated with COVID-19 in Lombardy, Italy.1 Of the 1591 predominantly older, male patients with comorbid conditions admitted to the intensive care units (ICUs) of 72 hospitals from February 20 to March 18, 2020, the majority had moderate to severe acute respiratory distress syndrome (ARDS). Overall, of the 88% of patients who underwent endotracheal intubation and mechanical ventilation, the median level of positive end-expiratory pressure (PEEP) was 14 cm H2O. In this cohort, 11% received noninvasive ventilation, exposure to which may have been even more extensive outside the ICU, in original or repurposed high-dependency units for patients with COVID-19, and 27% received early prone ventilation, reflecting the growing reports of using this strategy. By the end of the follow-up period, 26% of patients had died while 58% remained in the ICU. As reported in other series, older patients appeared to have the worst outcomes.1

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    2 Comments for this article
    Mortality
    Fabrizio Turrini, MD, MSc | AOU Modena, Italy
    I think the real mortality rate should be calculated among discharged patients not including those still in charge as reported in the abstract. Using these numbers (256 discharged and 405 died), the actual death rate will be 61%. Moreover there is a consistent (but still unknown) mortality rate after discharge from the ICU that should be taken into account.
    CONFLICT OF INTEREST: None Reported
    ECMO use
    Bilal Ali |
    Congratulations on your article. I was looking at use of ECMO within COVID and possibly looking to cite your article. I notice in table 1 you mention 5/498 patients received ECMO. However, there were a total of 1591 patients; does this mean that the remaining did not have ECMO available data? I was also wondering if it was successful at your follow up date or if you had any mortality in the 5 ECMO patients.

    Bilal
    Anaesthetic Core Trainee
    (alisbilal@gmail.com)
    CONFLICT OF INTEREST: None Reported
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