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Observational Study
. 2021 Jan;68(1):10-20.
doi: 10.1016/j.redar.2020.08.004. Epub 2020 Sep 4.

Critically ill COVID-19 patients attended by anesthesiologists in northwestern Spain: a multicenter prospective observational study

[Article in English, Spanish]
M Taboada  1 , P Rama  2 , R Pita-Romero  3 , E Moreno  4 , S Leal  5 , M Varela  6 , M Cid  7 , V Caruezo  8 , S Alvarado de la Torre  2 , M Corujeira  3 , A Sarmiento  4 , B Domínguez  5 , P Diaz  6 , L Cánovas  7 , M López Sánchez  2 , E Vilas  3 , A Rodríguez  4 , L Freire  5 , S Domínguez  6 , A Baluja  8 , P G Atanassoff  9
Affiliations
Observational Study

Critically ill COVID-19 patients attended by anesthesiologists in northwestern Spain: a multicenter prospective observational study

[Article in English, Spanish]
M Taboada et al. Rev Esp Anestesiol Reanim (Engl Ed). 2021 Jan.

Abstract
in English, Spanish

Background and objectives: There are limited information on outcome, complications and treatments of critically ill COVID-19 patients requiring admission to an intensive care unit (ICU). The aim of this study is to describe the clinical ICU course, treatments used, complications and outcomes, of critically ill COVID-19 patients admitted in seven ICU in Galicia region during the 2020 March-April pandemic peak.

Methods: Between March 21 and April 19, 2020, we evaluated critically ill COVID-19 patients admitted to the ICU of Anesthesia of seven hospitals in Galicia, northwestern Spain. Outcome, complications, and treatments were monitored until May 6, 2020, the final date of follow-up.

Results: A total of 97 critically ill COVID-19 patients were included. During ICU stay, mechanical ventilation became necessary in 80 (82.5%) patients, and tracheostomy in 22 (22.7%) patients. Prone position was used frequently in both intubated (67.5%) and awake (27.8%) patients. Medications consisted of antivirals agents (92.7%), corticosteroids (93.8%), tocilizumab (57.7%), and intermediate or high doses of anticoagulants (83.5%). The most frequent complications were ICU-acquired infection (52.6%), thrombosis events (16.5%), and reintubation (9.3%). After a median follow-up of 42 (34-45) days, 15 patients (15.5%) deceased, 73 patients (75.2%) had been discharged from ICU, and nine patients (9.3%) were still in the ICU.

Conclusions: A high proportion of our critically ill COVID-19 patients required mechanical ventilation, prone positioning, antiviral medication, corticosteroids, and anticoagulants. ICU complications were frequent, mainly infections and thrombotic events. We had a relatively low mortality of 15,5%.

Antecedentes y objetivos: Existe poca información sobre la evolución, complicaciones y los tratamientos recibidos por los pacientes críticos con COVID-19 que requieren ingreso en una unidad de cuidados intensivos (UCI). El objetivo de este estudio es describir la evolución clínica, los tratamientos utilizados, las complicaciones y resultados de pacientes críticos COVID-19 ingresados en siete UCI de Anestesiología en la Región de Galicia durante el pico de la pandemia en marzo-abril 2020.

Métodos: Entre el 21 de marzo y el 19 de abril de 2020 evaluamos todos los pacientes críticos COVID-19 ingresados en las UCI de Anestesiología de siete hospitales en Galicia, en el Noroeste de España. Los resultados, complicaciones y los tratamientos administrados se registraron hasta el 6 de Mayo de 2020, fecha final del seguimiento.

Resultados: Un total de 97 pacientes críticos COVID-19 fueron incluidos. Durante su estancia en UCI, 80 pacientes (82,5%) necesitaron ventilación mecánica, y 22 pacientes (22,7%) traqueotomía. El decúbito prono se usó frecuentemente en pacientes intubados (67,5%) y despiertos (27,8%). Las medicaciones usadas fueron antivirales (92,7%), corticoides (93,8%), tocilizumab (57,7%), y dosis intermedias y altas de anticoagulantes (83,5%). Las complicaciones más frecuentes fueron infecciones adquiridas en UCI (52,6%), eventos trombóticos (16,5%), y reintubationes (9,3%). Tras un seguimiento medio de 42 (34–45) días, 15 pacientes fallecieron (15,5%), 73 pacientes (75,2%) habían sido dados de alta de UCI y nueve pacientes (9,3%) permanecían todavía en la unidad.

Conclusiones: Un alto porcentaje de nuestros pacientes críticos COVID-19 requirieron ventilación mecánica, posición prona, medicaciones antivirales, corticoides y anticoagulantes. Las complicaciones en UCI fueron frecuentes, principalmente infecciones y eventos trombóticos. Tuvimos una mortalidad relativamente baja del 15,5%.

Keywords: Acute respiratory distress syndrome (ARDS); COVID-19; Corticoides; Corticosteroids; Critically ill patients; Decúbito prono; Pacientes críticos; Prone positioning; SARS-CoV-2; Síndrome de distrés respiratorio agudo (SDRA).

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Figures

Figure 1
Figure 1
Cumulative incidence of patients who died or were discharged from the ICU.
See this image and copyright information in PMC

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