For a COVID-19 patient, she’d be wearing more personal protective equipment (PPE)
JAMA Network has a descriptive account of 21 patients with COVID-19 admitted to the ICU at Evergreen Hospital in Kirkland, WA. Most cases were related to the nursing home outbreak and were admitted late Feb-early March, 2020. Average age was 70.
I’ve been wondering how many COVID-19 patients survive their period of intubation in the U.S. I still don’t know. That survival rate was abysmal in the one Chinese study I saw.
15 of these 21 patients required intubation and mechanical ventilation. As of March 17, the mortality rate was 67%, and 9.6% were discharged from the ICU. Current survivors are not out of the woods yet, so the mortality rate could trend upwards.
An abnormal chest radiograph was observed in 20 patients (95%) at admission. The most common findings on initial radiograph were bilateral reticular nodular opacities (11 patients [52%]) and ground-glass opacities (10 [48%]). By 72 hours, 18 patients (86%) had bilateral reticular nodular opacities and 14 (67%) had evidence of ground-glass opacities. The mean white blood cell count was 9365 μL at admission and 14 patients (67%) had a white blood cell count in the normal range. Fourteen patients (67%) had an absolute lymphocyte count of less than 1000 cells/μL. Liver function tests were abnormal in 8 patients (38%) at admission (Table 1).
Mechanical ventilation was initiated in 15 patients (71%) (Table 2). Acute respiratory distress syndrome (ARDS) was observed in 15 of 15 patients (100%) requiring mechanical ventilation and 8 of 15 (53%) developed severe ARDS by 72 hours. Although most patients did not present with evidence of shock, vasopressors were used for 14 patients (67%) during the illness. Cardiomyopathy developed in 7 patients (33%).
Steve Parker, M.D.
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