Epidemiology and ventilation characteristics of confirmed cases of severe COVID-19 pneumonia admitted in intensive care unit (EPIC19): A multicentre observational study

Background and aims: Coronavirus disease (COVID)-19 has spread across the globe. For a country like India with limited resources and a high population, it is worth knowing how these patients were managed. This prospective study was aimed to evaluate the patient characteristics and risk factors associated with mortality.

Methods: The study was conducted from 15 June 2020 to 31 December 2020 in four centres across India. Patients above 18 years of age admitted in the intensive care unit (ICU) with severe COVID-19 pneumonia were included. Details of oxygen therapy and ventilator characteristics were collected for seven days.

Results: Of 667 patients included in the study, the average age was 57 (standard deviation (SD) = 15) years and 70.46% were male. The ICU mortality was 60%. Acute physiology, age and chronic health evaluation (APACHE II) score was 29.8 (SD = 6.1). Among various significant risk factors, the need for invasive ventilator support on day 1 [odds ratio (OR): 3.11, 95% confidence interval (CI) (1.91-5.08)] and the development of arrhythmia [OR 3.85 CI (1.69,8.77) confidence interval (CI) (1.69, 8.77)] had higher odds of mortality. PF ratio [partial pressure of arterial oxygen/fraction of inspired oxygen] was 109.31 (77.79-187.26), maximum positive end-expiratory pressure was 10.29 (3.5) cmH₂O, driving pressure was 18.22 (6.16) cmH₂O, static compliance was 24.20 (8.57) ml/cmH₂O and dynamic compliance was 17.55 (5.18) ml/cmH₂O on day 1. Proning was used in 67 (22.41%) intubated patients and 44 (11.96%) awake patients.

Conclusion: In this cohort of patients, ICU mortality was 60%. The reason for higher mortality could be the severity of illness as suggested by day 1 PF ratio and APACHE II score.