Coronavirus Special Update #3 - The ICU Patient

The ICU Patient with Coronavirus

Summary

• Most COVID-19 ICU patients are classified as severe or critical

• COVID-19 ICU patients differ from typical ICU patients based on demographics; laboratory profile; use of resources; mortality

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Overview

COVID-19 patients are typically classified based on clinical findings with: mild, severe, or critical disease.  The typical distribution of these cases were characterized in a report of approximately 56,000 laboratory positive Chinese patients and are shown in Table 1.

We have learned a lot in the past few weeks, however recent events have provided a spotlight on the challenges of ICU care for COVID-19 patients.  There is limited data on ICU patient’s characteristics and outcomes.  Eight studies were reviewed evaluating COVID-19 positive patients from Italy (17,719 patients), China (2,179 patients), and the U.S. (45 patients).  The largest contribution of patients are from Italy, which may influence the overall results.

Characteristics & Outcomes

·         Of 22,347 patients, 2,038 (9.1%) were admitted to the ICU.

·         See Tables 2 & 3

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Conclusions

• ICU COVID-19 patients consist of those patients classified as critical disease and a subset of severe disease patients.

• ICU COVID-19 patients are demographically different than the typical ICU patient

• Differences include:

  o   Older and predominately male

  o   Greater comorbidities of cardiovascular disease and diabetes.

  o   Dramatically higher incidence on the use of invasive mechanical ventilation, vasopressors and the development of acute kidney injury

  o   Higher mortality rate

• Laboratory profile unique to COVID-19 patients

  Contact me to learn more about the unique characteristics of COVID-19 ICU patients.