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01-11-2020 | Care | Original

COVID-19 in critical care: epidemiology of the first epidemic wave across England, Wales and Northern Ireland

Authors: Alvin Richards-Belle, Izabella Orzechowska, Doug W. Gould, Karen Thomas, James C. Doidge, Paul R. Mouncey, Michael D. Christian, Manu Shankar-Hari, David A. Harrison, Kathryn M. Rowan, the ICNARC COVID-19 Team

Published in: Intensive Care Medicine | Issue 11/2020

Abstract

Purpose

To describe critical care patients with COVID-19 across England, Wales and Northern Ireland and compare them with a historic cohort of patients with other viral pneumonias (non-COVID-19) and with international cohorts of COVID-19.

Methods

Extracted data on patient characteristics, acute illness severity, organ support and outcomes from the Case Mix Programme, the national clinical audit for adult critical care, for a prospective cohort of patients with COVID-19 (February to August 2020) are compared with a recent retrospective cohort of patients with other viral pneumonias (non-COVID-19) (2017–2019) and with other international cohorts of critical care patients with COVID-19, the latter identified from published reports.

Results

10,834 patients with COVID-19 (70.1% male, median age 60 years, 32.6% non-white ethnicity, 39.4% obese, 8.2% at least one serious comorbidity) were admitted across 289 critical care units. Of these, 36.9% had a PaO₂/FiO₂ ratio of ≤ 13.3 kPa (≤ 100 mmHg) consistent with severe ARDS and 72% received invasive ventilation. Acute hospital mortality was 42%, higher than for 5782 critical care patients with other viral pneumonias (non-COVID-19) (24.7%), and most COVID-19 deaths (88.7%) occurred before 30 days. Meaningful international comparisons were limited due to lack of standardised reporting.

Conclusion

Critical care patients with COVID-19 were disproportionately non-white, from more deprived areas and more likely to be male and obese. Conventional severity scoring appeared not to adequately reflect their acute severity, with the distribution across PaO₂/FiO₂ ratio categories indicating acutely severe respiratory disease. Critical care patients with COVID-19 experience high mortality and place a great burden on critical care services.

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Title: COVID-19 in critical care: epidemiology of the first epidemic wave across England, Wales and Northern Ireland
Authors: Alvin Richards-Belle
Izabella Orzechowska
Doug W. Gould
Karen Thomas
James C. Doidge
Paul R. Mouncey
Michael D. Christian
Manu Shankar-Hari
David A. Harrison
Kathryn M. Rowan
the ICNARC COVID-19 Team
Publication date: 01-11-2020
Publisher: Springer Berlin Heidelberg
Keywords: Care
Pneumonia
COVID-19
Published in: Intensive Care Medicine / Issue 11/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06267-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

COVID-19 in critical care: epidemiology of the first epidemic wave across England, Wales and Northern Ireland

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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