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

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 18^th, 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.

Fig. 1

Percentages of ICU beds occupied on March 18^th, 2020 in Spain.

Fig. 2

Flowchart of detailing outcomes at day-7 post ICU admission.

Fig. 3

Outcomes for individual patients included in the manuscript (assessed April 6^th, 2020).

Fig. 4

Patients distribution with SARS-CoV-2 pneumonia according to survivors or non-survivors by PCT levels (A) four breakpoints of PCT levels (B) breakpoint of PCT level at 0.5.

Fig. 5

Patients’ distribution with SARS-CoV-2 pneumonia by PCT plasma levels and age: (A) by sex and PCT μg/L > 0.5; (B) by sex and PCT μg/L > 1; (C) by PCT μg/L ≤ 0.5vs. > 0.5 and ≤ 1 vs. > 0; (D) Alive and death by PCT μg/L; (E) Alive and death by PCT of patients with super-infection; (F) Alive and death by PCT of patients without super-infection. In figures A and B, the numbers indicate the total patients with positive PCT.

Fig. 6

Kaplan-Meier with 95% confidence interval (CI) representing mortality at 7 days based on PCT values. (A) PCT breakpoint at 0.5; (B) PCT breakpoint at 1. HFNT: High-flow nasal therapy; ECMO: extracorporeal membrane oxygenation.