Elsevier

Journal of Critical Care

Volume 58, August 2020, Pages 29-33
Journal of Critical Care

Clinical presentation and initial management critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Brescia, Italy

https://doi.org/10.1016/j.jcrc.2020.04.004Get rights and content
Under a Creative Commons license
open access

Highlights

  • COVID-19 is a global pandemic that has recently devastated Italy

  • Hospitals in Italy have experience strain on resources and used non-intensivists to manage critically ill patients.

  • Investigators created a severity scale for communicating with non-intensivist for triage and management

  • Hospitals should consider adapting or revising a severity scale when utilizing non-intensivist physicians.

Abstract

Purpose

An ongoing pandemic of COVID-19 that started in Hubei, China has resulted in massive strain on the healthcare infrastructure in Lombardy, Italy. The management of these patients is still evolving.

Materials and methods

This is a single-center observational cohort study of critically ill patients infected with COVID-19. Bedside clinicians abstracted daily patient data on history, treatment, and short-term course. We describe management and a proposed severity scale for treatment used in this hospital.

Results

44 patients were enrolled; with incomplete information on 11. Of the 33 studied patients, 91% were male, median age 64; 88% were overweight or obese. 45% were hypertensive, 12% had been taking an ACE-inhibitor. Noninvasive ventilation was performed on 39% of patients for part or all or their ICU stay with no provider infection. Most patients received antibiotics for pneumonia. Patients also received lopinivir/ritonavir (82%), hydroxychloroquine (79%), and tocilizumab (12%) according to this treatment algorithm. Nine of 10 patients survived their ICU course and were transferred to the floor, with one dying in the ICU.

Conclusions

ICU patients with COVID-19 frequently have hypertension. Many could be managed with noninvasive ventilation, despite the risk of aerosolization. The use of a severity scale augmented clinician management.

Keywords

Novel coronavirus
COVID-19
SARS-CoV-2

Cited by (0)

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Simone Piva and Matteo Filippini are equal contributors. Michael Lanspa and Nicola Latronico are equal contributors.