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This case series reviews 24 patients from nine Seattle-area hospitals who were admitted to the ICU with confirmed infection from SARS-CoV-2. There was evidence of community spread; none of the patients who developed COVID-19 had known exposure to a returning traveler. The patients had similar presentation of symptoms and comorbidities as that in other published cohorts, and 75% (n = 18) required mechanical ventilation. Interestingly, no patient had a positive test for influenza A, influenza B, or other respiratory viruses. Of the total cohort, 50% (n = 12) died between day 1 and day 18 of ICU admission; 4 patients had a do-not-resuscitate order on admission.
This experience of the COVID-19 pandemic in the early days in the US is similar to that experienced by other countries. The mortality rate was high among patients admitted to the ICU, with those having comorbid conditions and at an older age having a greater risk of severe disease and poor outcomes.
– Kolene Bailey, MD
This abstract is available on the publisher's site.
Community transmission of coronavirus 2019 (Covid-19) was detected in the state of Washington in February 2020.
We identified patients from nine Seattle-area hospitals who were admitted to the intensive care unit (ICU) with confirmed infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Clinical data were obtained through review of medical records. The data reported here are those available through March 23, 2020. Each patient had at least 14 days of follow-up.
We identified 24 patients with confirmed Covid-19. The mean (±SD) age of the patients was 64±18 years, 63% were men, and symptoms began 7±4 days before admission. The most common symptoms were cough and shortness of breath; 50% of patients had fever on admission, and 58% had diabetes mellitus. All the patients were admitted for hypoxemic respiratory failure; 75% (18 patients) needed mechanical ventilation. Most of the patients (17) also had hypotension and needed vasopressors. No patient tested positive for influenza A, influenza B, or other respiratory viruses. Half the patients (12) died between ICU day 1 and day 18, including 4 patients who had a do-not-resuscitate order on admission. Of the 12 surviving patients, 5 were discharged home, 4 were discharged from the ICU but remained in the hospital, and 3 continued to receive mechanical ventilation in the ICU.
During the first 3 weeks of the Covid-19 outbreak in the Seattle area, the most common reasons for admission to the ICU were hypoxemic respiratory failure leading to mechanical ventilation, hypotension requiring vasopressor treatment, or both. Mortality among these critically ill patients was high.
Covid-19 in Critically Ill Patients in the Seattle Region—Case Series
N. Engl. J. Med 2020 May 21;382(21)2012-2022, PK Bhatraju, BJ Ghassemieh, M Nichols, R Kim, KR Jerome, AK Nalla, AL Greninger, S Pipavath, MM Wurfel, L Evans, PA Kritek, TE West, A Luks, A Gerbino, CR Dale, JD Goldman, S O'Mahony, C Mikacenic