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Management and Outcomes of Critically-Ill Patients with COVID-19 Pneumonia at a Safety-net Hospital in San Francisco, a Region with Early Public Health Interventions: A Case Series.
- Vanderburg, Sky;
- Alipanah, Narges;
- Crowder, Rebecca;
- Yoon, Christina;
- Wang, Richard;
- Thakur, Neeta;
- Slown, Kristin;
- Shete, Priya B;
- Rofael, Martin;
- Metcalfe, John Z;
- Merrifield, Cindy;
- Marquez, Carina;
- Malcolm, Katherine;
- Lipnick, Michael;
- Jain, Vivek;
- Gomez, Antonio;
- Burns, Gregory;
- Brown, Lillian B;
- Berger, Christopher;
- Auyeung, Vincent;
- Cattamanchi, Adithya;
- Hendrickson, Carolyn M
- et al.
Published Web Location
https://doi.org/10.1101/2020.05.27.20114090Abstract
BACKGROUND:Following early implementation of public health measures, San Francisco has experienced a slow rise and a low peak level of coronavirus disease 2019 (COVID-19) cases and deaths. METHODS AND FINDINGS:We included all patients with COVID-19 pneumonia admitted to the intensive care unit (ICU) at the safety net hospital for San Francisco through April 8, 2020. Each patient had ≥15 days of follow-up. Among 26 patients, the median age was 54 years (interquartile range, 43 to 62), 65% were men, and 77% were Latinx. Mechanical ventilation was initiated for 11 (42%) patients within 24 hours of ICU admission and 20 patients (77%) overall. The median duration of mechanical ventilation was 13.5 days (interquartile range, 5 to 20). Patients were managed with lung protective ventilation (tidal volume <8 ml/kg of ideal body weight and plateau pressure ≤30 cmH2O on 98% and 78% of ventilator days, respectively). Prone positioning was used for 13 of 20 (65%) ventilated patients for a median of 5 days (interquartile range, 2 to 10). Seventeen (65%) patients were discharged home, 1 (4%) was discharged to nursing home, 3 (12%) were discharged from the ICU, and 2 (8%) remain intubated in the ICU at the time of this report. Three (12%) patients have died. CONCLUSIONS:Good outcomes were achieved in critically ill patients with COVID-19 by using standard therapies for acute respiratory distress syndrome (ARDS) such as lung protective ventilation and prone positioning. Ensuring hospitals can deliver sustained high-quality and evidence-based critical care to patients with ARDS should remain a priority.
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