SARS-CoV-2 in Spanish Intensive Care Units: Early experience with 15-day survival in Vitoria

Anaesth Crit Care Pain Med. 2020 Oct;39(5):553-561. doi: 10.1016/j.accpm.2020.04.001. Epub 2020 Apr 9.

Abstract

Purpose: Community transmission of SARS-CoV-2 was detected in Spain in February 2020, with 216% intensive care unit (ICU) capacity expanded in Vitoria by March 18th, 2020.

Methods: We identified patients from the two public hospitals in Vitoria who were admitted to ICU with confirmed infection by SARS-CoV-2. Data reported here were available in April 6th, 2020. Mortality was assessed in those who completed 15-days of ICU stay.

Results: We identified 48 patients (27 males) with confirmed SARS-CoV-2. Median [interquartile range (IQR)] age of patients was 63 [51-75] years. Symptoms began a median of 7 [5-12] days before ICU admission. The most common comorbidities identified were obesity (48%), arterial hypertension (44%) and chronic lung disease (37%). All patients were admitted by hypoxemic respiratory failure and none received non-invasive mechanical ventilation. Forty-five (94%) underwent intubation, 3 (6%) high flow nasal therapy (HFNT), 1 (2%) extracorporeal membrane oxygenation (ECMO) and 22 (46%) required prone position. After 15 days, 14/45 (31%) intubated patients died (13% within one week), 10/45 (22%) were extubated, and 21/45 (47%) underwent mechanical ventilation. Six patients had documented super-infection. Procalcitonin plasma above 0.5μg/L was associated with 16% vs. 19% (p=0.78) risk of death after 7 days.

Conclusion: This early experience with SARS-CoV-2 in Spain suggests that a strategy of right oxygenation avoiding non-invasive mechanical ventilation was life-saving. Seven-day mortality in SARS-CoV-2 requiring intubation was lower than 15%, with 80% of patients still requiring mechanical ventilation. After 15 days of ICU admission, half of patients remained intubated, whereas one third died.

Keywords: ARDS; COVID-19; Pneumonia; Procalcitonin.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antiviral Agents / therapeutic use
  • Betacoronavirus*
  • COVID-19
  • Combined Modality Therapy
  • Comorbidity
  • Coronavirus Infections / blood
  • Coronavirus Infections / complications
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / mortality*
  • Coronavirus Infections / therapy
  • Disease Outbreaks
  • Female
  • Hospital Mortality
  • Hospitals, Public / statistics & numerical data*
  • Humans
  • Influenza, Human / epidemiology
  • Intensive Care Units / statistics & numerical data*
  • Kaplan-Meier Estimate
  • Length of Stay
  • Male
  • Middle Aged
  • Oxygen Inhalation Therapy
  • Pandemics*
  • Pneumonia, Viral / blood
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / mortality*
  • Pneumonia, Viral / therapy
  • Procalcitonin / blood
  • Respiration, Artificial
  • Respiratory Distress Syndrome / etiology
  • Respiratory Distress Syndrome / mortality
  • Respiratory Distress Syndrome / therapy
  • SARS-CoV-2
  • Spain / epidemiology

Substances

  • Antiviral Agents
  • Procalcitonin

Supplementary concepts

  • COVID-19 drug treatment