Critical Care for Severe COVID-19: A Population-Based Study from a Province with Low Case-Fatality Rate in China

Background: Data regarding critical care for patients with severe COVID-19 are limited. We aimed to describe and analyse the clinical course, multi-strategy management, and respiratory support usage for the severe COVID-19 at the provincial level. Methods: Using data from Sichuan Provincial Department of Health and the population-based multicentre cohort study, all microbiologically confirmed COVID-19 patients in Sichuan who met the national severe criteria were included from January 16 to March 15, 2020. All patients were followed-up from the day of inclusion, noted as Day one (D1), until discharge, death, or the end of the study. Findings: Out of 539 COVID-19 patients, 81 severe cases (15·0%) were identified. The median (IQR) age was 50 (39-65) years, 37% were female, and 53·1% had chronic comorbidities. All severe cases were identified before requiring mechanical ventilation. Among the five predefined criteria for severe illness, low PaO2:FiO2 ratio (<300 mmHg) was the most commonly reported, accounting for 87·7% of the severe diagnosed. By establishing provisional ICUs, all 81 patients were admitted to hospitals capable of providing critical care, among whom 51 (63·0%) were treated in provisional ICUs. On D1, 77 patients (95·1%) were admitted, 76 (93·8%) were administered by respiratory support, including 51 (67·9%) by conventional oxygen therapy (COT). By D28, 53 (65·4%) were discharged, three (3·7%) were deceased, and 25 (30·9%) were still hospitalized. COT, administered to 95·1% of the patients, was the most commonly used respiratory support and met 62·7% of the respiratory support needed, followed by high-flow nasal cannula (19·5%) and non-invasive mechanical ventilation (10%). Interpretation: The multi-strategy management for severe COVID-19 patients included early identification and timely critical care, including appropriate respiratory support in particular. Preparation of sufficient conventional oxygen equipment should be prioritized. Funding Statement: This project was supported by Project of Novel Coronavirus Pneumonia in West China Hospital. Declaration of Interests: None. Ethics Approval Statement: The study protocol was approved by the Ethics Committee of the West China Hospital and the participating hospitals. Informed consent was obtained from the patient or the patient’s legally authorized representative.