The majority of critically ill patients with coronavirus disease 2019 (COVID-19) who were admitted to intensive care units (ICUs) in Italy were older men requiring mechanical ventilation, according to a retrospective case series published in JAMA.

Information about the clinical characteristics of patients infected with COVID-19 who require intensive care is limited. Knowledge of their baseline characteristics and outcomes is crucial for health and government officials engaged in planning efforts to address local outbreaks.

Thus, researchers collected demographic and clinical data from 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission at 1 of 72 hospitals in the Lombardy region of Italy between February 20 and March 18, 2020. The median patient age was 63 years and 82% were men.

Of the 1043 patients with available data, 68% had ≥1 comorbidity and 49% had hypertension. Of the 1300 patients with respiratory support data available, 99% needed respiratory support including 88% who received endotracheal intubation and mechanical ventilation, and 11% who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 cm H2O and the fraction of inspired oxygen (FiO2) was ≥50% in 89% of patients.


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Of the 1581 patients with ICU disposition data available as of March 25, 2020, 58% were still in the ICU, 16% were discharged from the ICU, and 26% had died in the ICU. Older patients (≥64 years) had significantly higher mortality compared with patients aged ≤63 years (36% vs 15%, respectively; P <.001).

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“In this case series of critically ill patients admitted to ICUs in Lombardy, Italy, with laboratory-confirmed COVID-19 from February 20 to March 18, 2020, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%,” concluded the authors.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Grasselli G, Zangrillo A, Zanella A, et al; for the COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy [published online April 6, 2020]. JAMA. doi:10.1001/jama.2020.5394