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Showing content from https://pubmed.ncbi.nlm.nih.gov/32250385/ below:

Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy

. 2020 Apr 28;323(16):1574-1581. doi: 10.1001/jama.2020.5394. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy Alberto Zangrillo^{3 4}, Alberto Zanella^{1 2}, Massimo Antonelli^{5 6}, Luca Cabrini⁷, Antonio Castelli⁸, Danilo Cereda⁹, Antonio Coluccello¹⁰, Giuseppe Foti^{11 12}, Roberto Fumagalli¹¹, Giorgio Iotti¹³, Nicola Latronico^{14 15}, Luca Lorini¹⁶, Stefano Merler¹⁷, Giuseppe Natalini¹⁸, Alessandra Piatti⁷, Marco Vito Ranieri¹⁹, Anna Mara Scandroglio³, Enrico Storti²⁰, Maurizio Cecconi^{21 22}, Antonio Pesenti^{1 2}; COVID-19 Lombardy ICU Network

Collaborators, Affiliations

Collaborators

COVID-19 Lombardy ICU Network: Emiliano Agosteo, Valentina Alaimo, Giovanni Albano, Andrea Albertin, Armando Alborghetti, Giorgio Aldegheri, Benvenuto Antonini, Enrico Barbara, Nicolangela Belgiorno, Mirko Belliato, Annalisa Benini, Enrico Beretta, Leonardo Bianciardi, Stefano Bonazzi, Massimo Borelli, Enrico Boselli, Nicola Bronzini, Carlo Capra, Livio Carnevale, Giampaolo Casella, Gianpaolo Castelli, Emanuele Catena, Sergio Cattaneo, Davide Chiumello, Silvia Cirri, Giuseppe Citerio, Sergio Colombo, Davide Coppini, Alberto Corona, Paolo Cortellazzi, Elena Costantini, Remo Daniel Covello, Gianluca De Filippi, Marco Dei Poli, Federica Della Mura, Giulia Evasi, Raquel Fernandez-Olmos, Andrea Forastieri Molinari, Marco Galletti, Giorgio Gallioli, Marco Gemma, Paolo Gnesin, Lorenzo Grazioli, Stefano Greco, Paolo Gritti, Paolo Grosso, Luca Guatteri, Davide Guzzon, Fabiola Harizay, Roberto Keim, Giovanni Landoni, Thomas Langer, Andrea Lombardo, Annalisa Malara, Elena Malpetti, Francesco Marino, Giovanni Marino, Maurizio Giovanni Mazzoni, Guido Merli, Antonio Micucci, Francesco Mojoli, Stefano Muttini, Adriana Nailescu, Mauro Panigada, Paolo Perazzo, Giovanni Battista Perego, Nicola Petrucci, Angelo Pezzi, Alessandro Protti, Danilo Radrizzani, Maurizio Raimondi, Marco Ranucci, Frank Rasulo, Mario Riccio, Roberto Rona, Claudio Roscitano, Patrizia Ruggeri, Antonello Sala, Giuseppe Sala, Luca Salvi, Pietro Sebastiano, Paolo Severgnini, Ilaria Sforzini, Francesco Donato Sigurtà, Matteo Subert, Paola Tagliabue, Carmine Troiano, Roberto Valsecchi, Uberto Viola, Giovanni Vitale, Massimo Zambon, Elena Zoia

Affiliations

¹ Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
² Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
³ Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁴ Vita-Salute San Raffaele University Milan, Italy.
⁵ Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁶ Università Cattolica del Sacro Cuore, Rome, Italy.
⁷ Università degli Studi dell'Insubria and Azienda Ospedaliera Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
⁸ Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario, University of Milan, Milan, Italy.
⁹ DG Welfare, Lombardy Region, Milan, Italy.
¹⁰ Department of Anesthesiology and Intensive Care, ASST Cremona - Ospedale di Cremona, Cremona, Italy.
¹¹ School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
¹² Department of Anesthesia and Intensive Care Medicine, ASST Monza, Monza, Italy.
¹³ Department of Anaesthesia and Intensive Care Unit, IRCCS San Matteo Hospital and University of Pavia, Pavia, Italy.
¹⁴ Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Spedali Civili University Hospital, Brescia, Italy.
¹⁵ Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
¹⁶ Department of Anaesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy.
¹⁷ Bruno Kessler Foundation, Trento, Italy.
¹⁸ Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, Brescia, Italy.
¹⁹ Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy.
²⁰ Dipartimento Emergenza Urgenza, UOC Anestesia e Rianimazione, ASST, Lodi, Italy.
²¹ Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Centre-IRCCS, Rozzano, Milan, Italy.
²² Humanitas University, Milan, Italy.

PMID: 32250385
PMCID: PMC7136855
DOI: 10.1001/jama.2020.5394

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Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy

Giacomo Grasselli et al. JAMA. 2020.

. 2020 Apr 28;323(16):1574-1581. doi: 10.1001/jama.2020.5394. Authors Giacomo Grasselli^{1 2}, Alberto Zangrillo^{3 4}, Alberto Zanella^{1 2}, Massimo Antonelli^{5 6}, Luca Cabrini⁷, Antonio Castelli⁸, Danilo Cereda⁹, Antonio Coluccello¹⁰, Giuseppe Foti^{11 12}, Roberto Fumagalli¹¹, Giorgio Iotti¹³, Nicola Latronico^{14 15}, Luca Lorini¹⁶, Stefano Merler¹⁷, Giuseppe Natalini¹⁸, Alessandra Piatti⁷, Marco Vito Ranieri¹⁹, Anna Mara Scandroglio³, Enrico Storti²⁰, Maurizio Cecconi^{21 22}, Antonio Pesenti^{1 2}; COVID-19 Lombardy ICU Network Collaborators

COVID-19 Lombardy ICU Network: Emiliano Agosteo, Valentina Alaimo, Giovanni Albano, Andrea Albertin, Armando Alborghetti, Giorgio Aldegheri, Benvenuto Antonini, Enrico Barbara, Nicolangela Belgiorno, Mirko Belliato, Annalisa Benini, Enrico Beretta, Leonardo Bianciardi, Stefano Bonazzi, Massimo Borelli, Enrico Boselli, Nicola Bronzini, Carlo Capra, Livio Carnevale, Giampaolo Casella, Gianpaolo Castelli, Emanuele Catena, Sergio Cattaneo, Davide Chiumello, Silvia Cirri, Giuseppe Citerio, Sergio Colombo, Davide Coppini, Alberto Corona, Paolo Cortellazzi, Elena Costantini, Remo Daniel Covello, Gianluca De Filippi, Marco Dei Poli, Federica Della Mura, Giulia Evasi, Raquel Fernandez-Olmos, Andrea Forastieri Molinari, Marco Galletti, Giorgio Gallioli, Marco Gemma, Paolo Gnesin, Lorenzo Grazioli, Stefano Greco, Paolo Gritti, Paolo Grosso, Luca Guatteri, Davide Guzzon, Fabiola Harizay, Roberto Keim, Giovanni Landoni, Thomas Langer, Andrea Lombardo, Annalisa Malara, Elena Malpetti, Francesco Marino, Giovanni Marino, Maurizio Giovanni Mazzoni, Guido Merli, Antonio Micucci, Francesco Mojoli, Stefano Muttini, Adriana Nailescu, Mauro Panigada, Paolo Perazzo, Giovanni Battista Perego, Nicola Petrucci, Angelo Pezzi, Alessandro Protti, Danilo Radrizzani, Maurizio Raimondi, Marco Ranucci, Frank Rasulo, Mario Riccio, Roberto Rona, Claudio Roscitano, Patrizia Ruggeri, Antonello Sala, Giuseppe Sala, Luca Salvi, Pietro Sebastiano, Paolo Severgnini, Ilaria Sforzini, Francesco Donato Sigurtà, Matteo Subert, Paola Tagliabue, Carmine Troiano, Roberto Valsecchi, Uberto Viola, Giovanni Vitale, Massimo Zambon, Elena Zoia

Affiliations

¹ Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
² Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
³ Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁴ Vita-Salute San Raffaele University Milan, Italy.
⁵ Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁶ Università Cattolica del Sacro Cuore, Rome, Italy.
⁷ Università degli Studi dell'Insubria and Azienda Ospedaliera Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
⁸ Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario, University of Milan, Milan, Italy.
⁹ DG Welfare, Lombardy Region, Milan, Italy.
¹⁰ Department of Anesthesiology and Intensive Care, ASST Cremona - Ospedale di Cremona, Cremona, Italy.
¹¹ School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
¹² Department of Anesthesia and Intensive Care Medicine, ASST Monza, Monza, Italy.
¹³ Department of Anaesthesia and Intensive Care Unit, IRCCS San Matteo Hospital and University of Pavia, Pavia, Italy.
¹⁴ Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Spedali Civili University Hospital, Brescia, Italy.
¹⁵ Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
¹⁶ Department of Anaesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy.
¹⁷ Bruno Kessler Foundation, Trento, Italy.
¹⁸ Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, Brescia, Italy.
¹⁹ Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy.
²⁰ Dipartimento Emergenza Urgenza, UOC Anestesia e Rianimazione, ASST, Lodi, Italy.
²¹ Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Centre-IRCCS, Rozzano, Milan, Italy.
²² Humanitas University, Milan, Italy.

PMID: 32250385
PMCID: PMC7136855
DOI: 10.1001/jama.2020.5394

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Erratum in

Addition of Nonauthor Collaborator Names of the COVID-19 Lombardy ICU Network.
[No authors listed] [No authors listed] JAMA. 2021 May 25;325(20):2120. doi: 10.1001/jama.2021.5060. JAMA. 2021. PMID: 33881479 Free PMC article. No abstract available.

Abstract

Importance: In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited.

Objective: To characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy.

Design, setting, and participants: Retrospective case series of 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinator center (Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network and treated at one of the ICUs of the 72 hospitals in this network between February 20 and March 18, 2020. Date of final follow-up was March 25, 2020.

Exposures: SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs.

Main outcomes and measures: Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center on an electronic worksheet during telephone calls by the staff of the COVID-19 Lombardy ICU Network.

Results: Of the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2O, and Fio2 was greater than 50% in 89% of patients. The median Pao2/Fio2 was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n = 503 aged ≤63 years) and older patients (n = 514 aged ≥64 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2O, respectively; median difference, 0 [95% CI, 0-0]; P = .94). Median Fio2 was lower in younger patients: 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, -10% [95% CI, -14% to 6%]; P = .006), and median Pao2/Fio2 was higher in younger patients: 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, -8 to 22]; P = .02). Patients with hypertension (n = 509) were older than those without hypertension (n = 526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68]; P < .001) and had lower Pao2/Fio2 (median [IQR], 146 [105-214] vs 173 [120-222]; median difference, -27 [95% CI, -42 to -12]; P = .005). Among the 1581 patients with ICU disposition data available as of March 25, 2020, 920 patients (58% [95% CI, 56%-61%]) were still in the ICU, 256 (16% [95% CI, 14%-18%]) were discharged from the ICU, and 405 (26% [95% CI, 23%-28%]) had died in the ICU. Older patients (n = 786; age ≥64 years) had higher mortality than younger patients (n = 795; age ≤63 years) (36% vs 15%; difference, 21% [95% CI, 17%-26%]; P < .001).

Conclusions and relevance: In this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Cecconi reported personal fees from Edwards Lifesciences, from Directed Systems, and from Cheetah Medical outside the submitted work. Dr Grasselli reported personal fees and nonfinancial support from Getinge and from Biotest, personal fees from Thermofisher, grants and personal fees from Fisher&Paykel, and personal fees from Draeger Medical outside the submitted work. Dr Iotti reported personal fees from Hamilton Medical, from Getinge Italia, from Eurosets, from Intersurgical, and from Burke & Burke outside the submitted work. Dr Pesenti reported personal fees from Maquet, from Novalung/Xenios, from Baxter, and from Boehringer Ingelheim outside the submitted work. No other disclosures were reported.

Figures
Figure.. Distribution of Age and Respiratory Measures…

Figure.. Distribution of Age and Respiratory Measures on Admission to a COVID-19 Intensive Care Unit
Figure.. Distribution of Age and Respiratory Measures on Admission to a COVID-19 Intensive Care Unit

COVID-19 indicates coronavirus disease 2019; PEEP, positive end-expiratory pressure; F io ₂, fraction of inspired oxygen; Pa o ₂, arterial partial pressure of oxygen. Boxplots show the 25th, 50th, and 75th percentiles (box); 10th and 90th percentiles (whiskers); and outlying points (circles).