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Management and Outcomes of Critically-III Patients with COVID-19 Pneumonia at a Safety-net Hospital in San Francisco, a Region with Early Public Health Interventions: A Case Series

BACKGROUND: Following early implementation of public health measures, San Francisco has experienced a slow rise and a low peak level of coronavirus disease 2019 (COVID-19) cases and deaths. METHODS AND FINDINGS: We included all patients with COVID-19 pneumonia admitted to the intensive care unit (IC...

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Autores principales: Vanderburg, Sky, Alipanah, Narges, Crowder, Rebecca, Yoon, Christina, Wang, Richard, Thakur, Neeta, Slown, Kristin, Shete, Priya B., Rofael, Martin, Metcalfe, John Z., Merrifield, Cindy, Marquez, Carina, Malcolm, Katherine, Lipnick, Michael, Jain, Vivek, Gomez, Antonio, Burns, Gregory, Brown, Lillian B., Berger, Christopher, Auyeung, Vincent, Cattamanchi, Adithya, Hendrickson, Carolyn M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cold Spring Harbor Laboratory 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273306/
https://www.ncbi.nlm.nih.gov/pubmed/32511538
http://dx.doi.org/10.1101/2020.05.27.20114090
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author Vanderburg, Sky
Alipanah, Narges
Crowder, Rebecca
Yoon, Christina
Wang, Richard
Thakur, Neeta
Slown, Kristin
Shete, Priya B.
Rofael, Martin
Metcalfe, John Z.
Merrifield, Cindy
Marquez, Carina
Malcolm, Katherine
Lipnick, Michael
Jain, Vivek
Gomez, Antonio
Burns, Gregory
Brown, Lillian B.
Berger, Christopher
Auyeung, Vincent
Cattamanchi, Adithya
Hendrickson, Carolyn M.
author_facet Vanderburg, Sky
Alipanah, Narges
Crowder, Rebecca
Yoon, Christina
Wang, Richard
Thakur, Neeta
Slown, Kristin
Shete, Priya B.
Rofael, Martin
Metcalfe, John Z.
Merrifield, Cindy
Marquez, Carina
Malcolm, Katherine
Lipnick, Michael
Jain, Vivek
Gomez, Antonio
Burns, Gregory
Brown, Lillian B.
Berger, Christopher
Auyeung, Vincent
Cattamanchi, Adithya
Hendrickson, Carolyn M.
author_sort Vanderburg, Sky
collection PubMed
description BACKGROUND: Following early implementation of public health measures, San Francisco has experienced a slow rise and a low peak level of coronavirus disease 2019 (COVID-19) cases and deaths. METHODS AND FINDINGS: We included all patients with COVID-19 pneumonia admitted to the intensive care unit (ICU) at the safety net hospital for San Francisco through April 8, 2020. Each patient had ≥15 days of follow-up. Among 26 patients, the median age was 54 years (interquartile range, 43 to 62), 65% were men, and 77% were Latinx. Mechanical ventilation was initiated for 11 (42%) patients within 24 hours of ICU admission and 20 patients (77%) overall. The median duration of mechanical ventilation was 13.5 days (interquartile range, 5 to 20). Patients were managed with lung protective ventilation (tidal volume ≤8 ml/kg of ideal body weight and plateau pressure ≤30 cmH(2)O on 98% and 78% of ventilator days, respectively). Prone positioning was used for 13 of 20 (65%) ventilated patients for a median of 5 days (interquartile range, 2 to 10). Seventeen (65%) patients were discharged home, 1 (4%) was discharged to nursing home, 3 (12%) were discharged from the ICU, and 2 (8%) remain intubated in the ICU at the time of this report. Three (12%) patients have died. CONCLUSIONS: Good outcomes were achieved in critically ill patients with COVID-19 by using standard therapies for acute respiratory distress syndrome (ARDS) such as lung protective ventilation and prone positioning. Ensuring hospitals can deliver sustained high-quality and evidence-based critical care to patients with ARDS should remain a priority.
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spelling pubmed-72733062020-06-07 Management and Outcomes of Critically-III Patients with COVID-19 Pneumonia at a Safety-net Hospital in San Francisco, a Region with Early Public Health Interventions: A Case Series Vanderburg, Sky Alipanah, Narges Crowder, Rebecca Yoon, Christina Wang, Richard Thakur, Neeta Slown, Kristin Shete, Priya B. Rofael, Martin Metcalfe, John Z. Merrifield, Cindy Marquez, Carina Malcolm, Katherine Lipnick, Michael Jain, Vivek Gomez, Antonio Burns, Gregory Brown, Lillian B. Berger, Christopher Auyeung, Vincent Cattamanchi, Adithya Hendrickson, Carolyn M. medRxiv Article BACKGROUND: Following early implementation of public health measures, San Francisco has experienced a slow rise and a low peak level of coronavirus disease 2019 (COVID-19) cases and deaths. METHODS AND FINDINGS: We included all patients with COVID-19 pneumonia admitted to the intensive care unit (ICU) at the safety net hospital for San Francisco through April 8, 2020. Each patient had ≥15 days of follow-up. Among 26 patients, the median age was 54 years (interquartile range, 43 to 62), 65% were men, and 77% were Latinx. Mechanical ventilation was initiated for 11 (42%) patients within 24 hours of ICU admission and 20 patients (77%) overall. The median duration of mechanical ventilation was 13.5 days (interquartile range, 5 to 20). Patients were managed with lung protective ventilation (tidal volume ≤8 ml/kg of ideal body weight and plateau pressure ≤30 cmH(2)O on 98% and 78% of ventilator days, respectively). Prone positioning was used for 13 of 20 (65%) ventilated patients for a median of 5 days (interquartile range, 2 to 10). Seventeen (65%) patients were discharged home, 1 (4%) was discharged to nursing home, 3 (12%) were discharged from the ICU, and 2 (8%) remain intubated in the ICU at the time of this report. Three (12%) patients have died. CONCLUSIONS: Good outcomes were achieved in critically ill patients with COVID-19 by using standard therapies for acute respiratory distress syndrome (ARDS) such as lung protective ventilation and prone positioning. Ensuring hospitals can deliver sustained high-quality and evidence-based critical care to patients with ARDS should remain a priority. Cold Spring Harbor Laboratory 2020-05-29 /pmc/articles/PMC7273306/ /pubmed/32511538 http://dx.doi.org/10.1101/2020.05.27.20114090 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/) , which allows reusers to copy and distribute the material in any medium or format in unadapted form only, for noncommercial purposes only, and only so long as attribution is given to the creator.
spellingShingle Article
Vanderburg, Sky
Alipanah, Narges
Crowder, Rebecca
Yoon, Christina
Wang, Richard
Thakur, Neeta
Slown, Kristin
Shete, Priya B.
Rofael, Martin
Metcalfe, John Z.
Merrifield, Cindy
Marquez, Carina
Malcolm, Katherine
Lipnick, Michael
Jain, Vivek
Gomez, Antonio
Burns, Gregory
Brown, Lillian B.
Berger, Christopher
Auyeung, Vincent
Cattamanchi, Adithya
Hendrickson, Carolyn M.
Management and Outcomes of Critically-III Patients with COVID-19 Pneumonia at a Safety-net Hospital in San Francisco, a Region with Early Public Health Interventions: A Case Series
title Management and Outcomes of Critically-III Patients with COVID-19 Pneumonia at a Safety-net Hospital in San Francisco, a Region with Early Public Health Interventions: A Case Series
title_full Management and Outcomes of Critically-III Patients with COVID-19 Pneumonia at a Safety-net Hospital in San Francisco, a Region with Early Public Health Interventions: A Case Series
title_fullStr Management and Outcomes of Critically-III Patients with COVID-19 Pneumonia at a Safety-net Hospital in San Francisco, a Region with Early Public Health Interventions: A Case Series
title_full_unstemmed Management and Outcomes of Critically-III Patients with COVID-19 Pneumonia at a Safety-net Hospital in San Francisco, a Region with Early Public Health Interventions: A Case Series
title_short Management and Outcomes of Critically-III Patients with COVID-19 Pneumonia at a Safety-net Hospital in San Francisco, a Region with Early Public Health Interventions: A Case Series
title_sort management and outcomes of critically-iii patients with covid-19 pneumonia at a safety-net hospital in san francisco, a region with early public health interventions: a case series
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273306/
https://www.ncbi.nlm.nih.gov/pubmed/32511538
http://dx.doi.org/10.1101/2020.05.27.20114090
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