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DOI: 10.1016/j.medine.2020.05.005
Available online 10 November 2020
Severe infection due to the SARS-CoV-2 coronavirus: Experience of a tertiary hospital with COVID-19 patients during the 2020 pandemic
Infección grave por coronavirus SARS-CoV-2: experiencia en un hospital de tercer nivel con pacientes afectados por COVID-19 durante la pandemia 2020
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A. Rodrígueza,b,
Corresponding author
ahr1161@yahoo.es

Corresponding author.
, G. Morenoa, J. Gómeza,c, R. Carbonella, E. Picó-Planad, C. Benavent Bofille, R. Sánchez Parrillaf, S. Treflera, E. Esteve Pitarchg, L. Canadellg, X. Teixidoh, L. Claveriasa, M. Bodía,b, on behalf of the HJ23-COVID-19 working group
a Servicio de Medicina Intensiva, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
b URV/IIPSV/CIBERES, Spain
c UCI23 Data análisis/URV /IISPV, Spain
d Servicio de Microbiología Clínica, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
e Laboratorio Central Área de Biología Molecular, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
f Laboratorio Central Urgencias, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
g Servicio de Farmacia Clínica, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
h Departamento de Enfermería, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
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Tables (2)
Table 1. General characteristics of the 43 patients with severe COVID-19.
Table 2. Variables related to oxygenation of the 43 patients, stratified according to outcome.
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Abstract
Objective

To describe the clinical and respiratory characteristics of a cohort of 43 patients with COVID-19 after an evolutive period of 28 days.

Design

A prospective, single-center observational study was carried out.

Setting

Intensive care.

Patients

Patients admitted due to COVID-19 and respiratory failure.

Interventions

None.

Variables

Automatic recording was made of demographic variables, severity parameters, laboratory data, assisted ventilation (HFO: high-flow oxygen therapy and IMV: invasive mechanical ventilation), oxygenation (PaO2, PaO2/FiO2) and complications. The patients were divided into three groups: survivors (G1), deceased (G2) and patients remaining under admission (G3). The chi-squared test or Fisher exact test (categorical variables) was used, along with the Mann-Whitney U-test or Wilcoxon test for analyzing the differences between medians. Statistical significance was considered for p < 0.05.

Results

A total of 43 patients were included (G1 = 28 [65.1%], G2 = 10 [23.3%] and G3 = 5[11.6%]), with a mean age of 65 years (range 52-72), 62% males, APACHE II 18 (15-24), SOFA 6 (4-7). Arterial hypertension (30.2%) and obesity (25.6%) were the most frequent comorbidities. High-flow oxygen therapy was used in 62.7% of the patients, with failure in 85%. In turn, 95% of the patients required IMV and 85% received ventilation in prone decubitus. In the general population, initial PaO2/FiO2 improved after 7 days (165 [125-210] vs.194 [153-285]; p = 0.02), in the same way as in G1 (164 [125-197] vs. 207 [160-294]; p = 0.07), but not in G2 (163 [95-197] vs. 135 [85-177]). No bacterial coinfection was observed. The incidence of IMV-associated pneumonia was high (13 episodes/1000 days of IMV).

Conclusions

Patients with COVID-19 require early IMV, a high frequency of ventilation in prone decubitus, and have a high incidence of failed HFO. The lack of improvement of PaO2/FiO2 at 7 days could be a prognostic marker.

Keywords:
COVID-19
Respiratory failure
Mechanical ventilation
Resumen
Objetivo

Describir las características clínicas y respiratorias de una cohorte de 43 pacientes con COVID-19 tras 28 días de evolución.

Diseño

Prospectivo observacional en un solo centro

Ámbito

Medicina intensiva

Pacientes

Pacientes ingresados por COVID-19 e insuficiencia respiratoria

Intervenciones

Ninguna.

Variables

Se obtuvieron de forma automática variables demográficas, de gravedad, de laboratorio, de asistencia ventilatoria recibida (OAF: oxigenoterapia alto flujo y VMI: ventilación mecánica invasiva), de oxigenación (PaO2, PaO2/FiO2) y de complicaciones. Los pacientes se dividieron en 3 grupos: supervivientes(G1), fallecidos(G2) y aquellos que continuaban ingresados(G3). Se utilizó “chi” cuadrado o Fisher (variables categóricas) y “U” Mann-Whitney o Wilcoxon para analizar la diferencia entre medianas. Se consideró significativo un valor de p < 0.05.

Resultados

Se incluyeron 43 pacientes (G1 = 28[65,1%],G2 = 10[23,3%] y G3 = 5[11,6%]), edad 65(52-72) años, 62% hombres, APACHE II 18(15-24), SOFA 6(4-7), Hipertensión arterial(30,2%) y obesidad(25,6%) fueron las comorbilidades más frecuentes. La OAF fue usada en el 62,7% de pacientes, 85% fracasó. El 95% de los pacientes necesitó VMI y el 85% ventilación en prono. En la población general, la PaO2/FiO2 inicial mejoró a los 7 días (165[125-210] vs. 194[153-285], p = 0.02), al igual que en G1(164[125-197] vs. 207[160-294], p = 0.07) pero no en G2 (163[95-197] vs. 135[85-177]). No se observó co-infección bacteriana. El desarrollo de neumonía asociada a la VMI fue elevado (13 episodios/1000 días de VMI).

Conclusiones

Los pacientes con Covid-19 requieren VMI precoz, elevada frecuencia de ventilación en prono y presentan alta prevalencia de fracaso a OAF. La falta de mejoría de la PaO2/FiO2 a los 7 días podría ser un marcador de pronóstico.

Palabras clave:
COVID-19
Insuficiencia respiratoria
Ventilación mecánica

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