A single-centre, prospective cohort study of COVID-19 patients admitted to ICU for mechanical ventilatory support.

Background Mortality rates in COVID-19 patients in need of mechanical ventilation are high, with wide variations between countries. Most studies were retrospective, and results may not be generalizable due to differences in demographics, healthcare organization and surge capacity. We present a cohort of mechanically ventilated COVID-19 patients from a resource-rich, publicly financed healthcare system. Methods Prospective study from a tertiary hospital. Consecutive SARS-CoV-2 positive adult patients admitted to the ICU for mechanical ventilation 10.03.20-04.05.20 were included. Triage and treatment were protocolized. High-dose dalteparin was adjusted by D-dimer. Demographics, treatments, and high-resolution physiological variables were collected. Outcomes were 30-day and hospital mortality. Data are medians(quartiles). Results Of the 1484 persons in the hospital catchment area testing positive for SARS-CoV-2, 201 (13.5%) were hospitalized. Thirty-eight (19%) patients were mechanically ventilated, of whom five (13%) died. Of 163 patients treated with supplemental oxygen, eight (5%) died. In ventilated patients (75% males, age 61 (53-70) years), severe, moderate, and mild ARDS was present in 25%, 70%, and 5%. Tidal volume ≤8 mL/kg ideal bodyweight was achieved in 34 (94%) of patients. Proning and neuromuscular blockers were used in 19 (54%) and 20 (61%). Duration of ventilation was 12 days (8-23). D-dimer peaked 3.8 mg/L (2.1-5.3), maximum dalteparin dose was 15,000 IU/24h (10,000-15,000). Despite organizational changes a high degree of adherence to treatment protocols was achieved. Conclusion In a prospective cohort study of mechanically ventilated COVID-19 patients treated in a resource-rich, publicly financed healthcare system, mortality was considerably lower than previously reported in retrospective studies.