Clinical presentation and initial management critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Brescia, Italy

J Crit Care. 2020 Aug;58:29-33. doi: 10.1016/j.jcrc.2020.04.004. Epub 2020 Apr 14.

Abstract

Purpose: An ongoing pandemic of COVID-19 that started in Hubei, China has resulted in massive strain on the healthcare infrastructure in Lombardy, Italy. The management of these patients is still evolving.

Materials and methods: This is a single-center observational cohort study of critically ill patients infected with COVID-19. Bedside clinicians abstracted daily patient data on history, treatment, and short-term course. We describe management and a proposed severity scale for treatment used in this hospital.

Results: 44 patients were enrolled; with incomplete information on 11. Of the 33 studied patients, 91% were male, median age 64; 88% were overweight or obese. 45% were hypertensive, 12% had been taking an ACE-inhibitor. Noninvasive ventilation was performed on 39% of patients for part or all or their ICU stay with no provider infection. Most patients received antibiotics for pneumonia. Patients also received lopinivir/ritonavir (82%), hydroxychloroquine (79%), and tocilizumab (12%) according to this treatment algorithm. Nine of 10 patients survived their ICU course and were transferred to the floor, with one dying in the ICU.

Conclusions: ICU patients with COVID-19 frequently have hypertension. Many could be managed with noninvasive ventilation, despite the risk of aerosolization. The use of a severity scale augmented clinician management.

Keywords: COVID-19; Novel coronavirus; SARS-CoV-2.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Betacoronavirus*
  • Cohort Studies
  • Coronavirus Infections* / complications
  • Coronavirus Infections* / diagnosis
  • Coronavirus Infections* / therapy
  • Critical Illness / therapy*
  • Disease Management
  • Female
  • Humans
  • Hypertension / therapy
  • Italy
  • Male
  • Middle Aged
  • Noninvasive Ventilation / methods
  • Pandemics*
  • Pneumonia, Viral* / complications
  • Pneumonia, Viral* / diagnosis
  • Pneumonia, Viral* / therapy
  • Prospective Studies
  • Severity of Illness Index
  • Triage / organization & administration

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2