Covid-19 enfeksiyonu tanısı ile yoğun bakımda takip edilen kritik hastaların retrospektif değerlendirilmesi: tek merkez deneyimi

Öz

Giriş: 11 Mart tarihinde, Dünya Sağlık Örgütü (DSÖ) tarafından ilan edilen COVİD-19 salgını sonrası, Mart’ın ikinci haftasından itibaren ülkemizde olgular bildirilmiştir. COVİD-19 olgularının %5’inde hastalığın seyri sırasında yoğun bakıma ünitesine (YBÜ) yatış ihtiyacı gelişmektedir. Bu çalışma ile YBÜ’de izlediğimiz kritik durumdaki COVİD-19 hastalarının klinik özelliklerinin tanınması, takip ve tedavisinin değerlendirilmesi amaçlanmıştır. Gereç ve yöntem: Bu çalışmada; Mart-Haziran 2020 tarihleri arasında, COVİD-19 enfeksiyonu tanısı alan 180 hastanın, Dahiliye YBÜ’ye kabul edilen 18 (%12,2) hasta değerlendirilmiştir. Bulgular: YBÜ'ye kabul edilen 18 hastadan 13'ünün (%72,2) invaziv solunum desteğine ihtiyacı vardı. Geri kalan hastalara (5 hasta, %27,8) non-invaziv ventilasyon tedavisi uygulandı. Hastaların 16'sında (%88,9) en az bir komorbiditeye rastlandı. Yoğun bakım ünitesine yatan hastaların, 28 günlük mortalitesi %55,6 iken hastane mortalitesi %61,1 idi. 60 günlük mortalite ise %66,7 olarak bulundu. Tartışma: YBÜ’ye kabul oranımız ve ölüm oranlarımız Çin, Amerika ve İtalya’dan bildirilen çalışmalara göre daha yüksek bulunmuş ve bunun muhtemel sebeplerinin hastaların ciddiyeti, invaziv mekanik ventilasyon ihtiyacı olduğu düşünülmüştür. Sonuç: Bu çalışma sonuçlarına göre COVİD-19 kritik seyirli hastaların risk faktörleri, takip ve tedavisinde kullandığımız yöntemler ortaya konulmuştur. Bu sonuçların gelecekteki takip ve tedavi yöntemlerine katkı sağlayabileceği düşünülmekle birlikte yeni çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• SARS-CoV2
• COVID 19 enfeksiyonu
• yoğun bakım
• ARDS

Retrospective evaluation of critical patients followed in ıntensive care with the diagnosis of Covid-19 ınfection: single center experience

Abstract

Introduction: After the COVID-19 outbreak announced by the World Health Organization (WHO) on March 11, cases have been reported in our country since the second week of March. In COVID-19 cases, the need for intensive care hospitalization develops in 5% during the course of the disease. With this study, it was aimed to recognize the characteristics, follow-up and treatment of patients in critical condition for COVID-19 in the intensive care unit (ICU). Materials and methods: Between March and June 2020, 180 adult patients were diagnosed with COVID-19, and 18 (12.2%) of them were admitted to Internal Medicine ICU Results: Thirteen (72.2%) of 18 patients admitted to the ICU needed invasive respiratory support. Non-invasive ventilation therapy was applied to the remaining patients (5 patients, 27.8%). At least one comorbidity was found in 16 of the patients (88.9%). 28-day mortality of patients hospitalized in the intensive care unit was 55.6%, while hospital mortality was 61.1%. 60-day mortality was found as 66.7%. Discussion: Although our admission rate to the Intensive Care Unit and our mortality rates were higher than the studies reported from China, America and Italy, it was thought that the possible reasons for this were due to the severity of the patients, the higher need for invasive mechanical ventilation. Conclusion: This study, in which the risk factors of COVID-19 patients with critical course, and the results of the methods we use in their follow-up and treatment, are thought to contribute to future follow-up and treatment methods, but new studies are needed.

Keywords

• SARS-CoV2
• COVID 19 infection
• intensive care unit
• ARDS

Kaynakça

1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506. https://doi.org/10.1016/S0140-6736(20)30183-5
2. Demirbilek Y, Pehlivantürk G, Özgüler ZÖ, Alp Meşe E. COVID-19 outbreak control, example of ministry of health of Turkey. Turk J Med Sci 2020;50:489-494. https://doi.org/10.3906/sag-2004-187
3. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the chinese center for disease control and prevention. JAMA 2020;323:1239-1242. https://doi.org/10.1001/jama.2020.2648
4. Shang Y, Pan C, Yang X, Zhong M, Shang X. Management of critically ill patients with COVID-19 in ICU: statement from front-line intensive care experts in Wuhan, China. Ann Intensive Care 2020;10:73. https://doi.org/10.1186/s13613-020-00689-1
5. Varatharaj A, Thomas N, Ellul MA, et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Lancet Psychiatry 2020;7:875-882. https://doi.org/10.1016/S2215-0366(20)30287-X
6. Berlin DA, Gulick RM, Martinez FJ. Severe Covid-19. N Engl J Med. 2020;383:2451-2460. https://doi.org/10.1056/NEJMcp2009575
7. Phua J, Weng L, Ling L, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med 2020;8:506-517. https://doi.org/10.1016/S2213-2600(20)30161-2
8. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8:475-481. https://doi.org/10.1016/S2213-2600(20)30079-5

9. Bhatraju PK, Ghassemieh BJ, Nichols M, et al. Covid-19 in critically Ill patients in the seattle region case series. N Engl J Med. 2020;382:2012-2022. https://doi.org/10.1056/NEJMoa2004500
10. Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the lombardy region, Italy. JAMA 2020;323:1574-1581. https://doi.org/10.1001/jama.2020.5394
11. Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med 2020;180:934-943. https://doi.org/10.1001/jamainternmed.2020.0994
12. Chen R, Liang W, Jiang M, et al. Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China. Chest 2020;158:97-105. https://doi.org/10.1016/j.chest.2020.04.010.
13. WHO. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance. https://www.who.int/publications/i/item/clinical-management-of-covid-19. 27 May 2020
14. Dawei Wang, Bo Hu, Chang Hu, M et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323:1061-1069. https://doi.org/10.1001/jama.2020.1585
15. Zuccari S, Damiani E, Domizi R, et al. Changes in cytokines, haemodynamics and microcirculation in patients with sepsis/septic shock undergoing continuous renal replacement therapy and blood purification with cytoSorb. Blood Purif 2020;49:107-113. https://doi.org/10.1159/000502540
16. Ye Q, Wang B, Mao J. The pathogenesis and treatment of the `Cytokine Storm’ in COVID-19. J Infect 2020;80:607-613. https://doi.org/10.1016/j.jinf.2020.03.037
17. Xu K, Cai H, Shen Y, Ni Q, et al. Management of COVID-19: the Zhejiang experience. J Zhejiang Univ (Med Sci) 2020;49:147-157. https://doi.org/10.3785/j.issn.1008-9292.2020.02.02
18. Erişkin hasta tedavisi. https://covid19.saglik.gov.tr/TR-66926/eriskin-hasta-tedavisi.html. Accessed 24 Dec 2020