Characteristics, Treatment, Outcomes and Cause of Death of Invasively Ventilated Patients with COVID-19 ARDS in Milan, Italy

Objective

Describe characteristics, daily care and outcomes of patients with coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS).

Design

Case series of 73 patients.

Setting

Large tertiary hospital in Milan.

Participants

Mechanically ventilated patients with confirmed COVID-19 admitted to the intensive care unit (ICU) between 20 February and 2 April 2020.

Main outcome measures

Demographic and daily clinical data were collected to identify predictors of early mortality.

Results

Of the 73 patients included in the study, most were male (83.6%), the median age was 61 years (interquartile range [IQR], 54–69 years), and hypertension affected 52.9% of patients. Lymphocytopenia (median, 0.77 x 10³ per mm³; IQR, 0.58–1.00 x 10³ per mm³), hyperinflammation with C-reactive protein (median, 184.5 mg/dL; IQR, 108.2–269.1 mg/dL) and pro-coagulant status with D-dimer (median, 10.1 μg/m; IQR, 5.0–23.8 μg/m) were present. Median tidal volume was 6.7 mL/kg (IQR, 6.0–7.5 mL/kg), and median positive end-expiratory pressure was 12 cmH₂O (IQR, 10–14 cmH₂O). In the first 3 days, prone positioning (12–16 h) was used in 63.8% of patients and extracorporeal membrane oxygenation in five patients (6.8%). After a median follow-up of 19.0 days (IQR, 15.0–27.0 days), 17 patients (23.3%) had died, 23 (31.5%) had been discharged from the ICU, and 33 (45.2%) were receiving invasive mechanical ventilation in the ICU. Older age (odds ratio [OR], 1.12; 95% CI, 1.04–1.22; P = 0.004) and hypertension (OR, 6.15; 95% CI, 1.75–29.11; P = 0.009) were associated with mortality, while early improvement in arterial partial pressure of oxygen (PaO₂) to fraction of inspired oxygen (Fio₂) ratio was associated with being discharged alive from the ICU (P = 0.002 for interaction).

Conclusions

Despite multiple advanced critical care interventions, COVID-19 ARDS was associated with prolonged ventilation and high short term mortality. Older age and pre-admission hypertension were key mortality risk factors.