Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study

被引：542

作者：

Schmidt, Matthieu ^{[3
]}

Hajage, David ^{[3
]}

Demoule, Alexandre ^{[3
]}

Pham, Tai ^{[2
]}

Combes, Alain ^{[3
]}

Dres, Martin ^{[3
]}

Lebbah, Said ^{[3
]}

Kimmoun, Antoine ^{[50
]}

Mercat, Alain ^{[1
]}

Beduneau, Gaetan

Palmyre, Jessica ^{[3
]}

Prevost, Margot

Asfar, Pierre ^{[1
]}

Beloncle, Francois ^{[1
]}

Demiselle, Julien ^{[1
]}

Pavot, Arthur ^{[2
]}

Monnet, Xavier ^{[2
]}

Richard, Christian ^{[2
]}

Mayaux, Julien ^{[3
]}

Beurton, Alexandra ^{[3
]}

Descamps, Richard ^{[4
]}

Joret, Aurelie ^{[4
]}

Du Cheyron, Damien ^{[4
]}

Pene, Frederic ^{[5
]}

Chiche, Jean-Daniel ^{[5
]}

Jozwiak, Mathieu ^{[5
]}

Jaubert, Paul ^{[5
]}

Voiriot, Guillaume ^{[6
]}

Fartoukh, Muriel ^{[6
]}

Teulier, Marion ^{[6
]}

Blayau, Clarisse ^{[6
]}

L'Her, Erwen ^{[7
]}

Aubron, Cecile ^{[7
]}

Bodenes, Laetitia ^{[7
]}

Ferriere, Nicolas ^{[7
]}

Auchabie, Johann ^{[8
]}

Le Meur, Anthony ^{[8
]}

Pignal, Sylvain ^{[8
]}

Mazzoni, Thierry ^{[8
]}

Quenot, Jean-Pierre ^{[9
]}

Andreu, Pascal ^{[9
]}

Roudau, Jean-Baptiste ^{[9
]}

Labruyere, Marie ^{[9
]}

Nseir, Saad ^{[10
]}

Preau, Sebastien ^{[10
]}

Poissy, Julien ^{[10
]}

Mathieu, Daniel ^{[10
]}

Benhamida, Sarah ^{[11
]}

Paulet, Remi ^{[11
]}

Roucaud, Nicolas ^{[11
]}

机构：

[1] CHU Angers, Angers, France

[2] Hop Bicetre, AP HP, Le Kremlin Bicetre, France

[3] Hop La Pitie Salpetriere, AP HP, Paris, France

[4] CHU Caen Normandie, Hop Cote Nacre, Caen, France

[5] Hop Cochin, AP HP, Paris, France

[6] Hop Tenon, AP HP, Paris, France

[7] CHRU Brest La Cavale Blanche, Brest, France

[8] Ctr Hosp Cholet, Cholet, France

[9] CHU Dijon Bourgogne, Dijon, France

[10] CHU Lille, Hop Roger Salengero, Lille, France

[11] Grp Hosp Nord Essonne, Longjumeau, France

[12] Hop Nord Marseille, AP HM, Marseille, France

[13] Hop Melun Senart, Melun, France

[14] Element Mil Reanimat SSA, Mulhouse, France

[15] CHU Nantes, Hop Hotel Dieu, Nantes, France

[16] CHU Nice, Hop Archet, Nice, France

[17] Ctr Hosp Orleans, Orleans, France

[18] CHU Guadeloupe, Pointe A Pitre, Guadeloupe, France

[19] Hop Miletrie, Poitiers, France

[20] Ctr Hosp Roanne, Roanne, France

[21] CHU Rouen, Hop Charles Nicolle, Rouen, France

[22] CHRU Tours, Hop Bretonneau, Tours, France

[23] Ctr Hosp Bretagne Atlantique, Vannes, France

[24] CHU Liege, Liege, Belgium

[25] Hop Edouard Herriot, Hosp Civils Lyon, Lyon, France

[26] Ctr Hosp Mans, Le Mans, France

[27] Ctr Hosp Versailles, Le Chesnay, France

[28] Hop Foch, Suresnes, France

[29] Hop Claude Galien, Quincy Sous Senart, France

[30] GHR Mulhouse Sud Alsace, Mulhouse, France

[31] Hop Antoine Beclere, AP HP, Clamart, France

[32] Hop Intercommunal Creteil, Creteil, France

[33] Hop Neurol, Hosp Civils Lyon, Lyon, France

[34] Hop Necker Enfants Malad, AP HP, Paris, France

[35] Hop Louis Pasteur, Ctr Hosp Publ Cotentin, Cherbourg En Cotentin, France

[36] CHU Rennes, Hop Pontchaillou, Rennes, France

[37] CHU Strasbourg, Hop Hautepierre, Strasbourg, France

[38] Ctr Hosp Terr Gaston Bourret, Noumea, France

[39] Ctr Hosp Compiegne Noyon, Compiegne, France

[40] Grp Hosp St Joseph, Paris, France

[41] Ctr Hosp Mem St Lo, St Lo, France

[42] Grand Hop Est Francilien, Jossigny, France

[43] Gustave Roussy, Villejuif, France

[44] Ctr Hosp Intercommunal Robert Ballanger, Aulnay Sous Bois, France

[45] Hop Edouard Herriot, Hosp Civiles Lyon, Lyon, France

[46] Ctr Hosp Avignon, Avignon, France

[47] Grp Hosp Diaconesses Croix St Simon, Paris, France

[48] CHU Clermont Ferrand, Hop Gabriel Montpied, Clermont Ferrand, France

[49] Hop Instruct Armees Percy, Clamart, France

[50] CHU Nancy, Hop Brabois, Vandoeuvre Les Nancy, France

来源：

INTENSIVE CARE MEDICINE | 2021年 / 47卷 / 01期

关键词：

Acute respiratory distress syndrome; Mechanical ventilation; COVID-19; Outcome; Mortality risk factor; RESPIRATORY-DISTRESS-SYNDROME; EPIDEMIOLOGY; SCORE; CARE;

D O I：

10.1007/s00134-020-06294-x

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Purpose To describe acute respiratory distress syndrome (ARDS) severity, ventilation management, and the outcomes of ICU patients with laboratory-confirmed COVID-19 and to determine risk factors of 90-day mortality post-ICU admission. Methods COVID-ICU is a multi-center, prospective cohort study conducted in 138 hospitals in France, Belgium, and Switzerland. Demographic, clinical, respiratory support, adjunctive interventions, ICU length-of-stay, and survival data were collected. Results From February 25 to May 4, 2020, 4643 patients (median [IQR] age 63 [54-71] years and SAPS II 37 [28-50]) were admitted in ICU, with day-90 post-ICU admission status available for 4244. On ICU admission, standard oxygen therapy, high-flow oxygen, and non-invasive ventilation were applied to 29%, 19%, and 6% patients, respectively. 2635 (63%) patients were intubated during the first 24 h whereas overall 3376 (80%) received invasive mechanical ventilation (MV) at one point during their ICU stay. Median (IQR) positive end-expiratory and plateau pressures were 12 (10-14) cmH(2)O, and 24 (21-27) cmH(2)O, respectively. The mechanical power transmitted by the MV to the lung was 26.5 (18.6-34.9) J/min. Paralyzing agents and prone position were applied to 88% and 70% of patients intubated at Day-1, respectively. Pulmonary embolism and ventilator-associated pneumonia were diagnosed in 207 (9%) and 1209 (58%) of these patients. On day 90, 1298/4244 (31%) patients had died. Among patients who received invasive or non-invasive ventilation on the day of ICU admission, day-90 mortality increased with the severity of ARDS at ICU admission (30%, 34%, and 50% for mild, moderate, and severe ARDS, respectively) and decreased from 42 to 25% over the study period. Early independent predictors of 90-day mortality were older age, immunosuppression, severe obesity, diabetes, higher renal and cardiovascular SOFA score components, lower PaO2/FiO(2) ratio and a shorter time between first symptoms and ICU admission. Conclusion Among more than 4000 critically ill patients with COVID-19 admitted to our ICUs, 90-day mortality was 31% and decreased from 42 to 25% over the study period. Mortality was higher in older, diabetic, obese and severe ARDS patients.

引用

页码：60 / 73

页数：14

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