TY - JOUR
T1 - COVID-19 in critical care
T2 - epidemiology of the first epidemic wave across England, Wales and Northern Ireland
AU - the ICNARC COVID-19 Team
AU - Richards-Belle, Alvin
AU - Orzechowska, Izabella
AU - Gould, Doug W.
AU - Thomas, Karen
AU - Doidge, James C.
AU - Mouncey, Paul R.
AU - Christian, Michael D.
AU - Shankar-Hari, Manu
AU - Harrison, David A.
AU - Rowan, Kathryn M.
AU - Banjo, Yemi
AU - Borowczak, Kasia
AU - Cousins, Tom
AU - Cummins, Peter
AU - Dalemo, Keji
AU - Darnell, Robert
AU - Demissie, Hanna
AU - Drikite, Laura
AU - Fleming, Andrew
AU - Frederiksen, Ditte
AU - Furnell, Sarah
AU - Hussein, Abdo
AU - Koelewyn, Abby
AU - Matthews, Tim
AU - Peters, Sam
AU - Samuels, Tyrone
AU - Saull, Michelle
N1 - Funding Information:
We thank and respect all those working in critical care units across England, Wales and Northern Ireland and contributing to the care of patients and, particularly, those responsible for submitting data rapidly and regularly during the emerging COVID-19 epidemic. Additional ICNARC COVID-19 Team members: Yemi Banjo, Kasia Borowczak, Tom Cousins, Peter Cummins, Keji Dalemo, Robert Darnell, Hanna Demissie, Laura Drikite, Andrew Fleming, Ditte Frederiksen, Sarah Furnell, Abdo Hussein, Abby Koelewyn, Tim Matthews, Sam Peters, Tyrone Samuels, and Michelle Saull.
Funding Information:
ICNARC funded study. Dr. Shankar-Hari is supported by the National Institute for Health Research Clinician Scientist Award (CS-2016-16-011). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, National Institute for Health Research or the Department of Health and Social Care. Acknowledgements
Publisher Copyright:
© 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Purpose: To describe critical care patients with COVID-19 across England, Wales and Northern Ireland and compare them with a historic cohort of patients with other viral pneumonias (non-COVID-19) and with international cohorts of COVID-19. Methods: Extracted data on patient characteristics, acute illness severity, organ support and outcomes from the Case Mix Programme, the national clinical audit for adult critical care, for a prospective cohort of patients with COVID-19 (February to August 2020) are compared with a recent retrospective cohort of patients with other viral pneumonias (non-COVID-19) (2017–2019) and with other international cohorts of critical care patients with COVID-19, the latter identified from published reports. Results: 10,834 patients with COVID-19 (70.1% male, median age 60 years, 32.6% non-white ethnicity, 39.4% obese, 8.2% at least one serious comorbidity) were admitted across 289 critical care units. Of these, 36.9% had a PaO2/FiO2 ratio of ≤ 13.3 kPa (≤ 100 mmHg) consistent with severe ARDS and 72% received invasive ventilation. Acute hospital mortality was 42%, higher than for 5782 critical care patients with other viral pneumonias (non-COVID-19) (24.7%), and most COVID-19 deaths (88.7%) occurred before 30 days. Meaningful international comparisons were limited due to lack of standardised reporting. Conclusion: Critical care patients with COVID-19 were disproportionately non-white, from more deprived areas and more likely to be male and obese. Conventional severity scoring appeared not to adequately reflect their acute severity, with the distribution across PaO2/FiO2 ratio categories indicating acutely severe respiratory disease. Critical care patients with COVID-19 experience high mortality and place a great burden on critical care services.
AB - Purpose: To describe critical care patients with COVID-19 across England, Wales and Northern Ireland and compare them with a historic cohort of patients with other viral pneumonias (non-COVID-19) and with international cohorts of COVID-19. Methods: Extracted data on patient characteristics, acute illness severity, organ support and outcomes from the Case Mix Programme, the national clinical audit for adult critical care, for a prospective cohort of patients with COVID-19 (February to August 2020) are compared with a recent retrospective cohort of patients with other viral pneumonias (non-COVID-19) (2017–2019) and with other international cohorts of critical care patients with COVID-19, the latter identified from published reports. Results: 10,834 patients with COVID-19 (70.1% male, median age 60 years, 32.6% non-white ethnicity, 39.4% obese, 8.2% at least one serious comorbidity) were admitted across 289 critical care units. Of these, 36.9% had a PaO2/FiO2 ratio of ≤ 13.3 kPa (≤ 100 mmHg) consistent with severe ARDS and 72% received invasive ventilation. Acute hospital mortality was 42%, higher than for 5782 critical care patients with other viral pneumonias (non-COVID-19) (24.7%), and most COVID-19 deaths (88.7%) occurred before 30 days. Meaningful international comparisons were limited due to lack of standardised reporting. Conclusion: Critical care patients with COVID-19 were disproportionately non-white, from more deprived areas and more likely to be male and obese. Conventional severity scoring appeared not to adequately reflect their acute severity, with the distribution across PaO2/FiO2 ratio categories indicating acutely severe respiratory disease. Critical care patients with COVID-19 experience high mortality and place a great burden on critical care services.
KW - Coronavirus
KW - COVID-19
KW - Critical care
KW - Outcomes
KW - Pandemic
UR - http://www.scopus.com/inward/record.url?scp=85092333964&partnerID=8YFLogxK
U2 - 10.1007/s00134-020-06267-0
DO - 10.1007/s00134-020-06267-0
M3 - Article
C2 - 33034689
AN - SCOPUS:85092333964
SN - 0342-4642
VL - 46
SP - 2035
EP - 2047
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 11
ER -