JAMA- Clinical Characteristics of Patients Who Died of Coronavirus Disease 2019 in China

The outbreak of coronavirus disease 2019 (COVID-19) has been very severe in China. To understand the characteristics of patients who die of COVID-19, we analyzed 168 patients with COVID-19–induced pneumonia who died. Methods This case series’ study protocol was approved by each local institutional ethics committees. Written informed consent was waived owing to the urgent need to collect data. Data were obtained from 21 hospitals in Wuhan, China. Demographic, comorbidity, and respiratory support data for 168 patients who died of COVID-19 between January 21 to 30, 2020, in these hospitals were collected. All patients were diagnosed as having COVID-19 according to World Health Organization guidance. Results All patients received oxygen therapy during their hospital stay. However, 46 patients (27.4%) only received nasal or face mask oxygen before they died. In addition, approximately one-third of patients (58 patients [34.5%]) received high-flow nasal oxygen therapy, and 72 patients (42.9%) received noninvasive ventilation. However, only 34 patients (20.2%) were intubated and received invasive mechanical ventilation, and 2 patients (1.2%) received extracorporeal membrane oxygenation treatment. Age was not a factor associated with intubation. Discussion The results of this case series show that only approximately one-fifth of patients who died of COVID-19 received invasive mechanical ventilation and further aggressive respiratory support prior to death, indicating that many patients had delayed intubation. Additionally, approximately 27% of patients only received nasal or face mask oxygen treatment before they died. Several reasons may explain this low proportion. First, some patients with severe hypoxemia did not have other symptoms, such as shortness of breath or dyspnea, also called silent hypoxemia. Second, the lack of enough invasive mechanical ventilators is an important reason that would prevent patients from receiving intubation. Third, a medical team that is not dominated by intensivists may not receive critical care training; therefore, they may be uncertain on the timing for when a patient requires intubation. Another interesting finding of this case series is that hypertension was the most common chronic comorbidity among patients who died. However, hypertension usually is not an independent risk factor associated with mortality in patients with sepsis. According to a study from earlier this year, severe acute respiratory syndrome coronavirus 2 infects the lungs through the angiotensin-converting enzyme II receptor. Further research is needed to find the mechanism of COVID-19. In addition, clinical studies are also needed to confirm whether angiotensin-converting enzyme inhibitors and angiotensin receptor blockers could be beneficial for patients with COVID-19.. This case series found that delayed intubation was common in the early stage of the COVID-19 epidemic in Wuhan. Potential reasons for the delay include lack of invasive mechanical ventilators and lack of specific clinical training for respiratory support. To read more- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2764293

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