Characteristics and Outcomes of COVID-19 Patients with Respiratory Failure Admitted to a "Pandemic Ready" Intensive Care Unit - Lessons from Singapore.
- Author:
Si Yuan CHEW
1
;
Yee Shay LEE
;
Deepak GHIMIRAY
;
Chee Keat TAN
;
Gerald Sw CHUA
Author Information
1. Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
- Publication Type:Journal Article
- MeSH:
APACHE;
Adult;
Aged;
Betacoronavirus;
Coronavirus Infections;
complications;
mortality;
therapy;
Critical Care;
organization & administration;
Female;
Hospital Mortality;
Hospitalization;
Humans;
Male;
Middle Aged;
Pandemics;
Pneumonia, Viral;
complications;
mortality;
therapy;
Respiration, Artificial;
Respiratory Insufficiency;
mortality;
therapy;
virology;
Retrospective Studies;
Singapore
- From:Annals of the Academy of Medicine, Singapore
2020;49(7):434-448
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Singapore was one of the first countries affected by the coronavirus disease 2019 (COVID-19) pandemic but has been able to prevent its healthcare system and intensive care units (ICU) from being overwhelmed. We describe the clinical features, management and outcomes of COVID-19 patients with respiratory failure admitted to our ICU.
MATERIALS AND METHODS:A case series of COVID-19 patients admitted to our ICU for respiratory failure from 7 February, with data censoring at 30 June 2020, was performed from a review of medical records.
RESULTS:Twenty-two COVID-19 patients were admitted to our ICU for respiratory failure. The median age was 54.5 years (IQR 30-45.5), 72.7% were male and had at least one comorbidity. The Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were 2.5 (IQR 1.25-7) and 10 (8.25-12) respectively. Thirteen patients required invasive mechanical ventilation (IMV) and had a median PaO2/FiO2 ratio of 194 mmHg (IQR 173-213) after intubation. The 28-day survival was 100%, with 2 patients demising subsequently. The overall ICU mortality rate was 9.1% at the time of data censoring. In IMV survivors, length of IMV and ICU stay were 11 days (IQR 9-17.75) and 16 days (IQR 12-32) respectively.
CONCLUSION:Low COVID-19 ICU mortality was observed in our "pandemic-ready" ICU. This was achieved by having adequate surge capacity to facilitate early ICU admission and IMV, lung protective ventilation, and slow weaning. Being able to maintain clinical standards and evidence-based practices without having to resort to rationing contributed to better outcomes.
