Covid-19 in Critically Ill Patients in the Seattle Region - Case Series

Abstract

Background: Community transmission of coronavirus 2019 (Covid-19) was detected in the state of Washington in February 2020.

Methods: We identified patients from nine Seattle-area hospitals who were admitted to the intensive care unit (ICU) with confirmed infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Clinical data were obtained through review of medical records. The data reported here are those available through March 23, 2020. Each patient had at least 14 days of follow-up.

Results: We identified 24 patients with confirmed Covid-19. The mean (±SD) age of the patients was 64±18 years, 63% were men, and symptoms began 7±4 days before admission. The most common symptoms were cough and shortness of breath; 50% of patients had fever on admission, and 58% had diabetes mellitus. All the patients were admitted for hypoxemic respiratory failure; 75% (18 patients) needed mechanical ventilation. Most of the patients (17) also had hypotension and needed vasopressors. No patient tested positive for influenza A, influenza B, or other respiratory viruses. Half the patients (12) died between ICU day 1 and day 18, including 4 patients who had a do-not-resuscitate order on admission. Of the 12 surviving patients, 5 were discharged home, 4 were discharged from the ICU but remained in the hospital, and 3 continued to receive mechanical ventilation in the ICU.

Conclusions: During the first 3 weeks of the Covid-19 outbreak in the Seattle area, the most common reasons for admission to the ICU were hypoxemic respiratory failure leading to mechanical ventilation, hypotension requiring vasopressor treatment, or both. Mortality among these critically ill patients was high. (Funded by the National Institutes of Health.).

Figure 1. Chest Radiographs and CT Images of a 55-Year-Old Patient with SARS-CoV-2.

An initial radiograph (anteroposterior view) of the chest at admission (Panel A) shows hazy opacities in the upper and mid lung zones. Another chest radiograph obtained approximately 24 hours after the initial presentation (Panel B) shows worsening multifocal air-space opacities. Axial CT images (Panels C and D) and coronal reformats (Panel E) obtained within 2 hours after the chest radiograph in Panel B show extensive ground glass opacities and occasional foci of consolidation.

Figure 2. Outcomes for Individual Patients Included in the Case Series.

Do-not-resuscitate (DNR) designates orders that were in place before hospital admission. As of March 23, 2020, a total of 12 patients (50%) had died. Six patients who had received mechanical ventilation had been extubated and three patients remained intubated. Five patients had been discharged from the hospital. All the patients had at least 14 days of follow up. Dashed red lines indicate censoring of data.