COVID-19 in critical care: epidemiology of the first epidemic wave across England, Wales and Northern Ireland.
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 +9 more
TLDR
Critical care patients with COVID-19 were disproportionately non-white, from more deprived areas and more likely to be male and obese, and conventional severity scoring appeared not to adequately reflect their acute severity, with the distribution across PaO2/FiO2 ratio categories indicating acutely severe respiratory disease.Abstract:
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. 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. 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. 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.read more
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Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.
Merryn Voysey,Clemens Sac.,Shabir A. Madhi,Lily Yin Weckx,P M Folegatti,Parvinder K. Aley,Brian Angus,Vicky L. Baillie,Shaun Barnabas,Q E Bhorat,S Bibi,Carmen Briner,P Cicconi,Andrea M. Collins,R Colin-Jones,Clare L. Cutland,Thomas C. Darton,Keertan Dheda,Duncan Cja.,Emary Krw.,Katie J. Ewer,Lee Fairlie,Saul N. Faust,Shuo Feng,Daniela M. Ferreira,Adam Finn,Anna Goodman,Catherine M. Green,Christopher A Green,Paul T. Heath,Christopher Hill,Helen Hill,Ian Hirsch,Hodgson Shc.,Allen Izu,S Jackson,D Jenkin,Joe Ccd.,S Kerridge,Anthonet Koen,Gaurav Kwatra,Rajeka Lazarus,Alison M. Lawrie,A Lelliott,Vincenzo Libri,Patrick J. Lillie,R Mallory,Mendes Ava.,Eveline Pipolo Milan,Angela M. Minassian,Alastair McGregor,Hazel Morrison,Y Mujadidi,Amit J Nana,P J O’Reilly,S D Padayachee,A Pittella,E Plested,Katrina M Pollock,M N Ramasamy,S Rhead,Alexandre Vargas Schwarzbold,Nisha Singh,Andrew Smith,R Song,Matthew D. Snape,Eduardo Sprinz,Rebecca K. Sutherland,R Tarrant,E. Thomson,M E Török,Mark Toshner,Turner Dpj.,Johan Vekemans,Tonya Villafana,Watson Mee.,C J Williams,Alexander D. Douglas,Hill Avs.,Teresa Lambe,Sarah C. Gilbert,Andrew J. Pollard +81 more
TL;DR: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials.
Journal ArticleDOI
Post-COVID syndrome in non-hospitalised patients with COVID-19: a longitudinal prospective cohort study.
Max Augustin,Philipp Schommers,Melanie Stecher,Felix Dewald,Lutz Gieselmann,Henning Gruell,Carola Horn,Kanika Vanshylla,Veronica Di Cristanziano,Luise Osebold,Maria Roventa,Toqeer Riaz,Nikolai Tschernoster,Janine Altmueller,Leonard Rose,Susanne Salomon,Vanessa Priesner,Jan Christoffer Luers,Christian Albus,Stephan Rosenkranz,Birgit S. Gathof,Gerd Fätkenheuer,Michael Hallek,Florian Klein,Isabelle Suárez,Clara Lehmann +25 more
TL;DR: The on-going presence of either shortness of breath, anosmia, ageusia or fatigue as long-lasting symptoms even in non-hospitalised patients was observed at four and seven months post-infection and summarised as post-COVID syndrome (PCS).
Journal ArticleDOI
Trends in Intensive Care for Patients with COVID-19 in England, Wales and Northern Ireland.
James C Doidge,Doug W Gould,Paloma Ferrando-Vivas,Paul R Mouncey,Karen Thomas,Manu Shankar-Hari,Manu Shankar-Hari,David A Harrison,Kathryn M Rowan +8 more
TL;DR: The population of patients with COVID-19 admitted to ICU, and the processes of care in ICUs, changed over the first wave of the epidemic, and after adjustment for important risk factors, there was a substantial improvement in patient outcomes.
Journal ArticleDOI
Allocating scarce intensive care resources during the COVID-19 pandemic: practical challenges to theoretical frameworks.
Alexander Supady,Alexander Supady,J. Randall Curtis,Darryl Abrams,Darryl Abrams,Roberto Lorusso,Thomas Bein,Joachim Boldt,Crystal E. Brown,Daniel Duerschmied,Victoria Metaxa,Daniel Brodie,Daniel Brodie +12 more
TL;DR: In this paper, a triage committee is proposed to provide policies and guidance for clinicians to help ensure equity in the application of rationing under crisis standards of care, and an approach guided by egalitarian principles, integrated with utilitarian principles, can support physicians at the bedside when they must ration scarce resources.
Journal ArticleDOI
Mortality and critical care unit admission associated with the SARS-CoV-2 lineage B.1.1.7 in England: an observational cohort study.
Martina Patone,Karen Thomas,Robert Hatch,Pui San Tan,Carol Coupland,Weiqi Liao,Paul R Mouncey,David A Harrison,Kathryn M Rowan,Peter Horby,Peter J. Watkinson,Julia Hippisley-Cox +11 more
TL;DR: In this paper, the authors explored the associations between SARS-CoV-2 infection with and without lineage B.1.7 and admission to a critical care unit (CCU), 28-day mortality, and overall mortality following CCU admission.
References
More filters
Journal ArticleDOI
APACHE II: a severity of disease classification system.
TL;DR: The form and validation results of APACHE II, a severity of disease classification system that uses a point score based upon initial values of 12 routine physiologic measurements, age, and previous health status, are presented.
Journal ArticleDOI
Acute respiratory distress syndrome: the Berlin Definition.
Ards Definition Task Force,V. Marco Ranieri,Gordon D. Rubenfeld,B. Taylor Thompson,Niall D. Ferguson,Ellen Caldwell,Eddy Fan,Luigi Camporota,Luigi Camporota,Arthur S. Slutsky +9 more
TL;DR: The updated and revised Berlin Definition for ARDS addresses a number of the limitations of the AECC definition and may serve as a model to create more accurate, evidence-based, critical illness syndrome definitions and to better inform clinical care, research, and health services planning.
Journal ArticleDOI
Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy.
Giacomo Grasselli,Giacomo Grasselli,Alberto Zangrillo,Alberto Zanella,Alberto Zanella,Massimo Antonelli,Massimo Antonelli,Luca Cabrini,Antonio Castelli,Danilo Cereda,Antonio Coluccello,Giuseppe Foti,Roberto Fumagalli,Giorgio Antonio Iotti,Nicola Latronico,Luca Lorini,Stefano Merler,Giuseppe Natalini,Alessandra Piatti,Marco Ranieri,Anna Mara Scandroglio,Enrico Storti,Maurizio Cecconi,Antonio Pesenti,Antonio Pesenti +24 more
TL;DR: Patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy were characterized, including data on clinical management, respiratory failure, and patient mortality.
Journal ArticleDOI
Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study.
Annemarie B Docherty,Ewen M Harrison,Christopher A Green,Hayley E Hardwick,Riinu Pius,Lisa Norman,Karl A Holden,Jonathan M. Read,Frank Dondelinger,Gail Carson,Laura Merson,James A. Lee,Daniel Plotkin,Louise Sigfrid,Sophie Halpin,Clare Jackson,Carrol Gamble,Peter Horby,Jonathan S. Nguyen-Van-Tam,Antonia Ho,Clark D Russell,Jake Dunning,Jake Dunning,Peter J. M. Openshaw,J Kenneth Baillie,Malcolm G Semple +25 more
TL;DR: In study participants, mortality was high, independent risk factors were increasing age, male sex, and chronic comorbidity, including obesity, and the importance of pandemic preparedness and the need to maintain readiness to launch research studies in response to outbreaks is shown.
Journal ArticleDOI
Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis.
Sterne Jac.,Srinivas Murthy,Janet V. Diaz,Arthur S. Slutsky,Judit Villar,Derek C. Angus,Djillali Annane,Azevedo Lcp.,Otavio Berwanger,Alexandre Biasi Cavalcanti,Dequin P-F.,Dequin P-F.,Bin Du,Jonathan Emberson,David Fisher,Bruno Giraudeau,Anthony C. Gordon,Anders Granholm,Cameron Green,Richard Haynes,N Heming,Higgins Jpt.,Higgins Jpt.,Peter Horby,Peter Jüni,Martin J Landray,A. Le Gouge,Marie Leclerc,Wei Shen Lim,Flávia Ribeiro Machado,Colin McArthur,Colin McArthur,Ferhat Meziani,Morten Hylander Møller,Anders Perner,M W Petersen,Jelena Savović,Jelena Savović,Bruno Martins Tomazini,Viviane C Veiga,Steven A R Webb,John C. Marshall +41 more
TL;DR: A prospective meta-analysis that pooled data from 7 randomized clinical trials that evaluated the efficacy of corticosteroids in 1703 critically ill patients with COVID-19 found that low-dose dexamethasone reduced mortality in hospitalized patients with Cohen's disease who required respiratory support.
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