Giacomo\u00a0Grasselli,\u00a0Alberto\u00a0Zangrillo,\u00a0Alberto\u00a0Zanella,\u00a0et al<\/h3>\n\n\n\nJAMA.\u00a0<\/em>Published online April 6, 2020. doi:10.1001\/jama.2020.5394<\/h3>\n\n\n\nAbstract<\/p>\n\n\n\n
Importance<\/strong><\/h3>\n\n\n\nIn December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited.<\/p>\n\n\n\n
Objective<\/strong><\/h3>\n\n\n\nTo characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy.<\/p>\n\n\n\n
Design, Setting, and Participants<\/strong><\/h3>\n\n\n\nRetrospective case series of 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinator center (Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network and treated at one of the ICUs of the 72 hospitals in this network between February 20 and March 18, 2020. Date of final follow-up was March 25, 2020.<\/p>\n\n\n\n
Exposures<\/strong><\/h3>\n\n\n\nSARS-CoV-2 infection confirmed by real-time reverse transcriptase\u2013polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs.<\/p>\n\n\n\n
Main Outcomes and Measures<\/strong><\/h3>\n\n\n\nDemographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center on an electronic worksheet during telephone calls by the staff of the COVID-19 Lombardy ICU Network.<\/p>\n\n\n\n
Results<\/strong><\/h3>\n\n\n\nOf the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2<\/sub>O, and Fio2<\/sub>\u00a0was greater than 50% in 89% of patients. The median Pao2<\/sub>\/Fio2<\/sub>\u00a0was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n\u2009=\u2009503 aged \u226463 years) and older patients (n\u2009=\u2009514 aged \u226564 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2<\/sub>O, respectively; median difference, 0 [95% CI, 0-0];\u00a0P<\/em>\u2009=\u2009.94). Median Fio2<\/sub>\u00a0was lower in younger patients: 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, \u221210% [95% CI, \u221214% to 6%];\u00a0P<\/em>\u2009=\u2009.006), and median Pao2<\/sub>\/Fio2<\/sub>\u00a0was higher in younger patients: 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, \u22128 to 22];\u00a0P<\/em>\u2009=\u2009.02). Patients with hypertension (n\u2009=\u2009509) were older than those without hypertension (n\u2009=\u2009526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68];\u00a0P<\/em>\u2009<\u2009.001) and had lower Pao2<\/sub>\/Fio2<\/sub>\u00a0(median [IQR], 146 [105-214] vs 173 [120-222]; median difference, \u221227 [95% CI, \u221242 to \u221212];\u00a0P<\/em>\u2009=\u2009.005). Among the 1581 patients with ICU disposition data available as of March 25, 2020, 920 patients (58% [95% CI, 56%-61%]) were still in the ICU, 256 (16% [95% CI, 14%-18%]) were discharged from the ICU, and 405 (26% [95% CI, 23%-28%]) had died in the ICU. Older patients (n\u2009=\u2009786; age \u226564 years) had higher mortality than younger patients (n\u2009=\u2009795; age \u226463 years) (36% vs 15%; difference, 21% [95% CI, 17%-26%];\u00a0P<\/em>\u2009<\u2009.001).<\/p>\n\n\n\n![\"\"\/](\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jama\/0\/m_joi200037f1.png?Expires=2147483647&Signature=fi4eTMDUx2FC2uvvqWEcXFRklU300dt-MFghK-NexlQgxOqEwmUolvCY2SqV315L3PjPIB9cN2n5vPGsI1NkZ7anb1dXRs6GSPrNMZu3GptpoAnT4QSXoLeOouTRMzd03muzKZTcbTLupHoLl72wX6~NoZWUtYgXEKOLDgje0BYWAGtERG5SUdiNNI2lSGqjdh4A5Q712d~4duy2VAiVLAISh7rPYbFRXXrhE-8RrzxqROuwfq3ny24tdaL72SW~PODduYXzmv6kNHCH52I7aA-8DDcrO6B2qJQwwlBJXDC4Kijjbah5yRHmCbNIMStx6bzkoBva0Z2Gq5n7AO1XFg__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\")
<\/figure>\n\n\n\n![\"\"\/](\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jama\/0\/m_joi200037t1.png?Expires=2147483647&Signature=YGT-Wggl~NWxrjiSKjKZzt62Cs18bZygM-NHLo~WzMTsnBoJBrwvb4Q-zH~GMfXbVVCe39Z9IdLQw~KPBlM1~rNCEmLryb0Nt-ca1cmPwpQQAW15fpaGOlXV5USBCEEza~ASI85ZO9eeAPS51qu4T2FbTLPOqOUfZFX1kV0XX3ggXMyBgnz6OCWhg2pzeMeMN3pBx4hf8gyF6IfQONm7P8suciszQiH2NdCI1Sbso4ZHQPjfYM16SEInHPgVN0akd1iutoQjJCkWguLIlOKHfmFaW74XldnkaBHusp4gj0l-Aui8IeBrvhngnE0oMcFuuTfFfT9-VMigp-Qvtcz17w__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\")
<\/figure>\n\n\n\n![\"\"\/](\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jama\/0\/m_joi200037t2.png?Expires=2147483647&Signature=K0osrZkCBrkkOzJtOeCxVDmbAk2lKGFXSXZCzQlE4QQp7QbonS7j1P6Pg9waDIeuvSqT4e6xwUkuNgQWPhPiSMP8lKG0G-oAdCVbkiLQq4McjaJA3ImjOZNcqbnlZfWiWk09btmJNXi09thupOdPQOz-48Kjm-2o0d28aNvFg4bUPrVeRoVUEiXDNE1blHqqtSEdHCcpyYt483yJmIkNNQxtz8haX~wj-nMybaTta7n3yo-fu-yqonyIyYmL-j3GMyRVW2qKV74iagJJbACgWKPMKHI0PL0YelOqUGpbtZWt56apnEF4uJ3yS1YnyMNeJ8xZArtLQ77QFD5g0ROY-g__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\")
<\/figure>\n\n\n\nConclusions and Relevance<\/strong><\/h3>\n\n\n\nIn this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%.<\/p>\n","protected":false},"excerpt":{"rendered":"
Original Investigation April 6, 2020 Bas […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18842"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18842"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18842\/revisions"}],"predecessor-version":[{"id":18844,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18842\/revisions\/18844"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18842"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18842"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18842"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Abstract<\/p>\n\n\n\n
Importance<\/strong><\/h3>\n\n\n\nIn December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited.<\/p>\n\n\n\n
Objective<\/strong><\/h3>\n\n\n\nTo characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy.<\/p>\n\n\n\n
Design, Setting, and Participants<\/strong><\/h3>\n\n\n\nRetrospective case series of 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinator center (Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network and treated at one of the ICUs of the 72 hospitals in this network between February 20 and March 18, 2020. Date of final follow-up was March 25, 2020.<\/p>\n\n\n\n
Exposures<\/strong><\/h3>\n\n\n\nSARS-CoV-2 infection confirmed by real-time reverse transcriptase\u2013polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs.<\/p>\n\n\n\n
Main Outcomes and Measures<\/strong><\/h3>\n\n\n\nDemographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center on an electronic worksheet during telephone calls by the staff of the COVID-19 Lombardy ICU Network.<\/p>\n\n\n\n
Results<\/strong><\/h3>\n\n\n\nOf the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2<\/sub>O, and Fio2<\/sub>\u00a0was greater than 50% in 89% of patients. The median Pao2<\/sub>\/Fio2<\/sub>\u00a0was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n\u2009=\u2009503 aged \u226463 years) and older patients (n\u2009=\u2009514 aged \u226564 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2<\/sub>O, respectively; median difference, 0 [95% CI, 0-0];\u00a0P<\/em>\u2009=\u2009.94). Median Fio2<\/sub>\u00a0was lower in younger patients: 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, \u221210% [95% CI, \u221214% to 6%];\u00a0P<\/em>\u2009=\u2009.006), and median Pao2<\/sub>\/Fio2<\/sub>\u00a0was higher in younger patients: 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, \u22128 to 22];\u00a0P<\/em>\u2009=\u2009.02). Patients with hypertension (n\u2009=\u2009509) were older than those without hypertension (n\u2009=\u2009526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68];\u00a0P<\/em>\u2009<\u2009.001) and had lower Pao2<\/sub>\/Fio2<\/sub>\u00a0(median [IQR], 146 [105-214] vs 173 [120-222]; median difference, \u221227 [95% CI, \u221242 to \u221212];\u00a0P<\/em>\u2009=\u2009.005). Among the 1581 patients with ICU disposition data available as of March 25, 2020, 920 patients (58% [95% CI, 56%-61%]) were still in the ICU, 256 (16% [95% CI, 14%-18%]) were discharged from the ICU, and 405 (26% [95% CI, 23%-28%]) had died in the ICU. Older patients (n\u2009=\u2009786; age \u226564 years) had higher mortality than younger patients (n\u2009=\u2009795; age \u226463 years) (36% vs 15%; difference, 21% [95% CI, 17%-26%];\u00a0P<\/em>\u2009<\u2009.001).<\/p>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\nConclusions and Relevance<\/strong><\/h3>\n\n\n\nIn this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%.<\/p>\n","protected":false},"excerpt":{"rendered":"
Original Investigation April 6, 2020 Bas […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18842"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18842"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18842\/revisions"}],"predecessor-version":[{"id":18844,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18842\/revisions\/18844"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18842"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18842"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18842"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
To characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy.<\/p>\n\n\n\n
Design, Setting, and Participants<\/strong><\/h3>\n\n\n\nRetrospective case series of 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinator center (Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network and treated at one of the ICUs of the 72 hospitals in this network between February 20 and March 18, 2020. Date of final follow-up was March 25, 2020.<\/p>\n\n\n\n
Exposures<\/strong><\/h3>\n\n\n\nSARS-CoV-2 infection confirmed by real-time reverse transcriptase\u2013polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs.<\/p>\n\n\n\n
Main Outcomes and Measures<\/strong><\/h3>\n\n\n\nDemographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center on an electronic worksheet during telephone calls by the staff of the COVID-19 Lombardy ICU Network.<\/p>\n\n\n\n
Results<\/strong><\/h3>\n\n\n\nOf the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2<\/sub>O, and Fio2<\/sub>\u00a0was greater than 50% in 89% of patients. The median Pao2<\/sub>\/Fio2<\/sub>\u00a0was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n\u2009=\u2009503 aged \u226463 years) and older patients (n\u2009=\u2009514 aged \u226564 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2<\/sub>O, respectively; median difference, 0 [95% CI, 0-0];\u00a0P<\/em>\u2009=\u2009.94). Median Fio2<\/sub>\u00a0was lower in younger patients: 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, \u221210% [95% CI, \u221214% to 6%];\u00a0P<\/em>\u2009=\u2009.006), and median Pao2<\/sub>\/Fio2<\/sub>\u00a0was higher in younger patients: 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, \u22128 to 22];\u00a0P<\/em>\u2009=\u2009.02). Patients with hypertension (n\u2009=\u2009509) were older than those without hypertension (n\u2009=\u2009526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68];\u00a0P<\/em>\u2009<\u2009.001) and had lower Pao2<\/sub>\/Fio2<\/sub>\u00a0(median [IQR], 146 [105-214] vs 173 [120-222]; median difference, \u221227 [95% CI, \u221242 to \u221212];\u00a0P<\/em>\u2009=\u2009.005). Among the 1581 patients with ICU disposition data available as of March 25, 2020, 920 patients (58% [95% CI, 56%-61%]) were still in the ICU, 256 (16% [95% CI, 14%-18%]) were discharged from the ICU, and 405 (26% [95% CI, 23%-28%]) had died in the ICU. Older patients (n\u2009=\u2009786; age \u226564 years) had higher mortality than younger patients (n\u2009=\u2009795; age \u226463 years) (36% vs 15%; difference, 21% [95% CI, 17%-26%];\u00a0P<\/em>\u2009<\u2009.001).<\/p>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\nConclusions and Relevance<\/strong><\/h3>\n\n\n\nIn this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%.<\/p>\n","protected":false},"excerpt":{"rendered":"
Original Investigation April 6, 2020 Bas […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18842"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18842"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18842\/revisions"}],"predecessor-version":[{"id":18844,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18842\/revisions\/18844"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18842"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18842"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18842"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
SARS-CoV-2 infection confirmed by real-time reverse transcriptase\u2013polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs.<\/p>\n\n\n\n
Main Outcomes and Measures<\/strong><\/h3>\n\n\n\nDemographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center on an electronic worksheet during telephone calls by the staff of the COVID-19 Lombardy ICU Network.<\/p>\n\n\n\n
Results<\/strong><\/h3>\n\n\n\nOf the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2<\/sub>O, and Fio2<\/sub>\u00a0was greater than 50% in 89% of patients. The median Pao2<\/sub>\/Fio2<\/sub>\u00a0was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n\u2009=\u2009503 aged \u226463 years) and older patients (n\u2009=\u2009514 aged \u226564 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2<\/sub>O, respectively; median difference, 0 [95% CI, 0-0];\u00a0P<\/em>\u2009=\u2009.94). Median Fio2<\/sub>\u00a0was lower in younger patients: 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, \u221210% [95% CI, \u221214% to 6%];\u00a0P<\/em>\u2009=\u2009.006), and median Pao2<\/sub>\/Fio2<\/sub>\u00a0was higher in younger patients: 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, \u22128 to 22];\u00a0P<\/em>\u2009=\u2009.02). Patients with hypertension (n\u2009=\u2009509) were older than those without hypertension (n\u2009=\u2009526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68];\u00a0P<\/em>\u2009<\u2009.001) and had lower Pao2<\/sub>\/Fio2<\/sub>\u00a0(median [IQR], 146 [105-214] vs 173 [120-222]; median difference, \u221227 [95% CI, \u221242 to \u221212];\u00a0P<\/em>\u2009=\u2009.005). Among the 1581 patients with ICU disposition data available as of March 25, 2020, 920 patients (58% [95% CI, 56%-61%]) were still in the ICU, 256 (16% [95% CI, 14%-18%]) were discharged from the ICU, and 405 (26% [95% CI, 23%-28%]) had died in the ICU. Older patients (n\u2009=\u2009786; age \u226564 years) had higher mortality than younger patients (n\u2009=\u2009795; age \u226463 years) (36% vs 15%; difference, 21% [95% CI, 17%-26%];\u00a0P<\/em>\u2009<\u2009.001).<\/p>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\nConclusions and Relevance<\/strong><\/h3>\n\n\n\nIn this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%.<\/p>\n","protected":false},"excerpt":{"rendered":"
Original Investigation April 6, 2020 Bas […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18842"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18842"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18842\/revisions"}],"predecessor-version":[{"id":18844,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18842\/revisions\/18844"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18842"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18842"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18842"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Of the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2<\/sub>O, and Fio2<\/sub>\u00a0was greater than 50% in 89% of patients. The median Pao2<\/sub>\/Fio2<\/sub>\u00a0was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n\u2009=\u2009503 aged \u226463 years) and older patients (n\u2009=\u2009514 aged \u226564 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2<\/sub>O, respectively; median difference, 0 [95% CI, 0-0];\u00a0P<\/em>\u2009=\u2009.94). Median Fio2<\/sub>\u00a0was lower in younger patients: 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, \u221210% [95% CI, \u221214% to 6%];\u00a0P<\/em>\u2009=\u2009.006), and median Pao2<\/sub>\/Fio2<\/sub>\u00a0was higher in younger patients: 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, \u22128 to 22];\u00a0P<\/em>\u2009=\u2009.02). Patients with hypertension (n\u2009=\u2009509) were older than those without hypertension (n\u2009=\u2009526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68];\u00a0P<\/em>\u2009<\u2009.001) and had lower Pao2<\/sub>\/Fio2<\/sub>\u00a0(median [IQR], 146 [105-214] vs 173 [120-222]; median difference, \u221227 [95% CI, \u221242 to \u221212];\u00a0P<\/em>\u2009=\u2009.005). Among the 1581 patients with ICU disposition data available as of March 25, 2020, 920 patients (58% [95% CI, 56%-61%]) were still in the ICU, 256 (16% [95% CI, 14%-18%]) were discharged from the ICU, and 405 (26% [95% CI, 23%-28%]) had died in the ICU. Older patients (n\u2009=\u2009786; age \u226564 years) had higher mortality than younger patients (n\u2009=\u2009795; age \u226463 years) (36% vs 15%; difference, 21% [95% CI, 17%-26%];\u00a0P<\/em>\u2009<\u2009.001).<\/p>\n\n\n\n In this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%.<\/p>\n","protected":false},"excerpt":{"rendered":" Original Investigation April 6, 2020 Bas […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18842"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18842"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18842\/revisions"}],"predecessor-version":[{"id":18844,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18842\/revisions\/18844"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18842"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18842"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18842"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}<\/figure>\n\n\n\n<\/figure>\n\n\n\n<\/figure>\n\n\n\nConclusions and Relevance<\/strong><\/h3>\n\n\n\n