Severe COVID-19 in the intensive care unit: a case series

Hariyanto H., Yahya C.Q., Aritonang R.C.A.

Faculty of Medicine, Department of Anesthesiology and Intensive Care, Universitas Pelita Harapan, Jl. M. H. Thamrin Boulevard 1100, Lippo Village Tangerang, Tangerang, Banten 15811, Indonesia; Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No 77, Jakarta Pusat, 10430, Indonesia; Siloam Hospitals Kelapa Dua, Jl. Kelapa Dua Raya No.1001, Kelapa Dua, Tangerang, Banten 15810, Indonesia


Abstract

Background: Coronavirus disease 2019 (COVID-19) was first identified in Indonesia in March 2020, and the number of infections has grown exponentially. The situation is at its worst, overwhelming intensive care unit (ICU) resources and capacity. Case presentation: This is a single-center observational case study of 21 confirmed COVID-19 patients admitted to the ICU from March 20, 2020, to April 31, 2020. Demographics, baseline comorbidities, clinical symptoms, laboratory tests, electrocardiogram (ECG) and chest imaging were obtained consecutively during patient care. We identified 21 patients with confirmed COVID-19 severe infection in our ICU. The mean (± standard deviation) age of the patients was 54 ± 10 years; 95% were men, with shortness of breath (90.6%) the most common symptom. Hypertension was identified as a comorbidity in 28.6% of patients. The most common reason for admission to the ICU was hypoxemic respiratory failure, with 80% (17 patients) requiring mechanical ventilation. Half of the patients (10) died between day 1 and day 18, with septic shock as the primary cause of death. Of the 11 surviving patients, five were discharged home, while six were discharged from the ICU but remained in the hospital ward. Even then, the median length of ICU stay amongst survivors was 18 days. Conclusions: To date, there are no known effective antiviral agents or specific therapy to treat COVID-19. As severe systemic inflammatory response and multiple organ failure seems to be the primary cause of death, supportive care in maintaining oxygenation and hemodynamic stability remain the mainstay goals in treating critically ill COVID-19 patients. © 2021, The Author(s).

Case report; COVID-19; ICU; Mechanical ventilation; Respiratory failure; Septic shock; Severe infection


Journal

Journal of Medical Case Reports

Publisher: BioMed Central Ltd

Volume 15, Issue 1, Art No 259, Page – , Page Count


Journal Link: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85105198319&doi=10.1186%2fs13256-021-02799-1&partnerID=40&md5=e5b4ca83dd05aec07a1a292f27fde4db

doi: 10.1186/s13256-021-02799-1

Issn: 17521947

Type: All Open Access, Gold, Green


References

(2020) Coronavirus Disease (COVID-19) Situation Reports; Yang, X., Yu, Y., Xu, J., Shu, H., Ja, X., Liu, H., Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study (2020) Lancet Respir Med, 8 (5), pp. 475-481. , COI: 1:CAS:528:DC%2BB3cXjvVWqt70%3D; Wang, D., Hu, B., Hu, C., Zhu, F., Liu, X., Zhang, J., Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan China (2020) JAMA, 323 (11), pp. 1061-1069. , COI: 1:CAS:528:DC%2BB3cXlvVSqtbY%3D; Shi, H., Han, X., Jiang, N., Cao, Y., Alwalid, O., Gu, J., Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study (2020) Lancet Infect Dis, 20 (4), pp. 425-434. , COI: 1:CAS:528:DC%2BB3cXjvFWhtbs%3D; Gattinoni, L., Chiumello, D., Caironi, P., Busana, M., Romitti, F., Brazzi, L., COVID-19 pneumonia: different respiratory treatments for different phenotypes? (2020) Intensive Care Med, 46 (6), pp. 1099-1102. , COI: 1:CAS:528:DC%2BB3cXnsVait70%3D; Gibson, P.G., Qin, L., Puah, S.H., COVID-19 acute respiratory distress syndrome (ARDS): clinical features and differences from typical pre-COVID-19 ARDS (2020) Med J Aust, 213 (2), pp. 54-56; Gattinoni, L., Pesenti, A., Carlesso, E., Body position changes redistribute lung computed-tomographic density in patients with acute respiratory failure: impact and clinical fallout through the following 20 years (2013) Intensive Care Med, 39 (11), pp. 1909-1915; Scholten, E.L., Beitler, J.R., Prisk, G.K., Malhotra, A., Treatment of ARDS with prone positioning (2017) Chest, 151 (1), pp. 215-224; Jankelson, L., Karam, G., Becker, M.L., Chinitz, L.A., Tsai, M.C., QT prolongation, torsades de pointes, and sudden death with short courses of chloroquine or hydroxychloroquine as used in COVID-19: a systematic review (2020) Heart Rhythm, 17 (9), pp. 1472-1479; Coz Yatacodisease, A.S.Q.C., Sepsis: A nudge toward antibiotic stewardship (2019) Chest; Li, H., Liu, L., Zhang, D., Xu, J., Dai, H., Tang, N., SARS-CoV-2 and viral sepsis: observations and hypotheses (2020) Lancet, 395 (10235), pp. 1517-1520. , COI: 1:CAS:528:DC%2BB3cXnsVWrurg%3D; The, L.R., High-stakes heterogeneity in COVID-19 (2020) Lancet Rheumatol, 2 (10); Zhang, Y., Xiao, M., Zhang, S., Xia, P., Cao, W., Jiang, W., Coagulopathy and antiphospholipid antibodies in patients with COVID-19 (2020) N Engl J Med, 382 (17); Villapol, S., Gastrointestinal symptoms associated with COVID-19: Impact on the gut microbiome (2020) Transl Res; Fifi, J.T., Mocco, J., COVID-19 related stroke in young individuals (2020) Lancet Neurol, 19 (9), pp. 713-715. , COI: 1:CAS:528:DC%2BB3cXhs1ejsb7O

Indexed by Scopus

Leave a Comment