Draegerwerk Ag & Co. Kgaa · XETR:DRW8

Draegerwerk Ag & Co. Kgaa — Dräger Global Webinar Series June 2020

32 slides from Draegerwerk Ag & Co. Kgaa's conference presentation, June 2020

  1. Slide 1: COVID-19 outbreak in Italy: ICU response and patient clinical characteristics

    COVID-19 outbreak in Italy: ICU response and patient clinical characteristics Prof . Giacomo Grasselli • Associate Professor of Anesthesiology and Intensive Care Medicine, Dept of Pathophysiology and Transplantation, University of Milan • Medical Director, Intensive Care Unit «E. Vecla», Ospedale Ma

  2. Slide 2: Was this seasonal flu?

    Was this seasonal flu? Figura 3. Numero di campioni respiratori inviati dai medici sentinella e numero di campioni positivi per virus influenzali, virus respiratorio sinciziale (RSV) e Sars-CoV2 (monitorato a partire dalla settimana 8-2020}, stagione 2019-2020, Lombardia (aggiornamento 18-03-2020).

  3. Slide 3: Background

    Background • February 20, 2020: first patient diagnosed with COVID-19 diagnosed in Lombardy • March 11, 2020: WHO declares the SARS-CoV-2 outbreak as a pandemic • March 20, 2020: Italy is the second most affected country in the world, after China • Information on the clinical characteristics of crit

  4. Slide 4: Epidemiological situation in Italy

    Epidemiological situation in Italy https://www.epicentro.iss.it/en/coronavirus/bollettino/Infografica_3giugno%20ENG.pdf

  5. Slide 5: Epidemiological situation in Italy

    Epidemiological situation in Italy https://www.epicentro.iss.it/coronavirus/bollettino/Infografica_26mar%20ENG.pdf

  6. Slide 6: The case of mortality

    The case of mortality • Testing strategy (denominator) • Population age • Definition of COVID-19 related deaths Onder et al, JAMA 2020

  7. Slide 7: February 20: a healthy 30-year-old man with atypical pneumonia

    • February 20: a healthy 30-year-old man with atypical pneumonia unresponsive to treatment is tested positive in Codogno • February 21: 36 new positive cases, without links to patient 1 • Pre-crisis total regional ICU capacity: 750 beds (2.9% of total hospital beds) Emergency task force by the Gover

  8. Slide 8: March 20: 1218 pts in ICU

    March 20: 1218 pts in ICU Grasselli et al., JAMA March 2020

  9. Slide 9: The response in Lombardy

    The response in Lombardy • Increased ICU surge capacity to 1750 ICU beds (250 for non- COVID pts) • Network of COVID-19 ICUs with central coordination • Hospital Network reorganized: few hubs for specific diseases • Stopped elective surgical procedures • Containment measures Grasselli et al., JAMA M

  10. Slide 10: Pts admitted to COVID-19 ICUs

    Pts admitted to COVID-19 ICUs 1511 1079 • 95 COVID-ICUs in 72 Hospitals • Total patients: 3963 • Discharged: 1487 • Dead: 1440 • Currently in ICU: 1079

  11. Slide 11: Pts admitted to COVID-19 ICUs

    Pts admitted to COVID-19 ICUs • 95 COVID-ICUs in 72 Hospitals • Total patients: 4585 • Discharged: 2558 • Dead: 1920 • Currently in ICU: 118

  12. Slide 12: Pts admitted to COVID-19 ICUs

    Pts admitted to COVID-19 ICUs

  13. Slide 13: Take-home message: GET READY!!!

    Take-home message: GET READY!!! • Significant mismatch between the number of pts requiring ICU admission and available ICU beds • Increase ICU capacity and establish a network of cohorted “COVID- 19 ICUs” with central coordination to optimize patient allocation • Healthcare workers should be trained

  14. Slide 14: Clinical Presentation

    Clinical Presentation • COVID-19 typically presents with systemic and/or respiratory manifestations • Common ‒ fever (85-90%) ‒ cough (65-70%) ‒ fatigue (35-40%) ‒ sputum production (30-35%) ‒ shortness of breath (15-20%)

  15. Slide 15: Clinical Presentation

    Clinical Presentation • LESS COMMON: • RARE: ̶ myalgia/arthralgia (10-15%) ̶ nausea (<10%) ̶ headaches (10-15%) ̶ vomiting (<10%) ̶ nasal congestion (<10%) ̶ sore throat (10-15%) ̶ diarrhea (<5%) ̶ chills (10-12%) ̶ palpitations (<5%) ̶ pleuritic pain ̶ chest tightness (<5%) • Attn: some individuals

  16. Slide 16: Clinical Presentation

    Clinical Presentation • 81%  Mild disease: non-pneumonia and mild pneumonia. • 14%  Severe disease: dyspnea, RR ≥ 30/min, blood oxygen saturation (SpO2) ≤ 93%, PaO2/FiO2 ratio or P/F < 300, and/or lung infiltrates > 50% within 24 to 48 hours. • 5%  Critical disease: respiratory failure, septic sh

  17. Slide 17: Radiological Presentation

    Radiological Presentation Chest RX: patchy or diffuse asymmetric airspace opacities

  18. Slide 18: Radiological Presentation

    Radiological Presentation Chest CT: ground-glass opacification with or without consolidative abnormalities, with peripheral distribution, more likely bilateral and at lower lobes

  19. Slide 19: Data collection: 1591 patients with confirmed SARS-CoV-2 infection

    • Data collection: 1591 pts with confirmed SARS-CoV-2 infection admitted to the Lombardy COVID-19 ICU Network from February 20 to March 18 • Data recorded on an electronic worksheet during daily telephone calls • Data recorded at ICU admission: age, sex and medical comorbidities; mode of respiratory

  20. Slide 20: Demographic data: gender

    Demographic data: gender Overall population Critically ill 18% 82% CFR higher in males (15% vs 8%) similarly distributed among age groups

  21. Slide 21: Demographic data: age

    Demographic data: age 1000 939 900 800 700 600 570 Median (IQR): 63 500 (56-70) years 400 300 200 100 56 4 22 0 0-19 20-40 41-60 61-80 81-100 Grasselli et al., JAMA April 2020

  22. Slide 22: Comorbidities

    Comorbidities • 68% had at least one comorbidity • All patients >80 years and 76% of patients >60 years had at least one comorbidity • Hypertension was the most common comorbidity (49%) • The second most common comorbidities were cardiovascular disease (21%), other (20%) and hypercholesterolemia (18

  23. Slide 23: Respiratory support

    Respiratory support • Among 1300 patients with available data, 99% needed respiratory support: ‒ 88% required mechanical ventilation ‒ 11% required non-invasive ventilation • At admission, 27% of patients were treated with prone ventilation (N = 875) • Only 5 patients (1%) required ECMO (N = 498) •

  24. Slide 24: Respiratory support: PaO2/FiO2 and PEEP

    Respiratory support 22 550 20 500 PaO2/FiO2 (mmHg) 18 450 PEEP (cmH2O) 16 400 14 350 12 300 10 250 8 200 6 150 4 100 2 0 50 N = 999 Median: 14 (12-16) mmHg Median 70% Median: 160 (114-220) mmHg Not statistically different Higher in older patients Higher in younger patients between ages (median diffe

  25. Slide 25: Outcome: mortality

    Outcome: mortality • 920 (58%) of patients were still admitted in ICU Length of stay in ICU: 9 (6-13) days 100 • 256 (16%) were discharged from ICU ICU death rate within different age groups 90 • 405 (26%) had died in ICU 80 70 ICU mortality 29,4 60 50 40 30 20 70,6 10 00-63 yrs 64-100 yrs 0 All 00-

  26. Slide 26: Outcome: ICU length of stay

    Outcome: ICU length of stay N Mean ± SD Median (IQR) Min Max Deaths 189 (34%) 8.6 ± 5.2 8 (4-12) 0 24 Discharged 173 (31%) 8.3 ± 5.4 8 (4-12) 0 24 Still in ICU 191 (35%) 16.8 ± 5.3 17 (15-20) 1 32 Total 553 11.4 ± 6.6 12 (5-17) 0 32 Pts admitted to ICU until March 8 – outcome on March 23

  27. Slide 27: ICU and hospital outcomes by hospital status

    ICU Hospital All* Dead in Discharged Still in Dead in Discharged Still in ICU from ICU ICU Hospital from Hospital Hospital No. 1715 836 865 14 915 673 127 (%) (100) (49) (50) (1) (53) (39) (7)

  28. Slide 28: ICU and hospital outcomes by sex and age

    ICU Hospital All* Dead in Discharg Still in P Dead in Discharg Still in P ICU ed from ICU Hospital ed from Hospita ICU Hospital l 1398 700 688 10 763 534 101 Male (81) (50) (49) (1) (55) (38) (7) 0.03 0.046 317 136 177 4 152 139 26 Female (185) (43) (56) (1) (48) (44) (8) Age, 64 67.5 59 62 <0.001 6

  29. Slide 29: Comorbidities by ICU outcome

    ICU All* Dead in ICU Discharged from Still in ICU P ICU Dead vs Discharged Comorbidities 594 (55.1) 474 (44.0) 10 (0.9) <0.001 None 574/1652 (34.7) 211 (36.8) 359 (62.5) 4 (0.7) <0.001 Hypertension 890/1703 (52.3) 500 (56.2) 382 (42.9) 8 (0.9) <0.001 Hypercholesterole 302/1652 (18.3) 191 (63.2) 110

  30. Slide 30: Time to ICU admission and length of stay

    ICU Hospital All* Dead in Discharged Still in P Dead in Discharged Still in P ICU from ICU ICU Dead vs Hospital from Hospital Dead vs Discharg Hospital Discharged ed Time from 8 (4-11) 7 (4-10) 8 (5-11) 8.5 (3.5- 0.14 7 (4-10) 8 (5-11) 8 (4-11) 0.07 onset of (N=1588) (N=769) (N=807) 10.5) (N=844) (N

  31. Slide 31: Limitations

    Limitations • Retrospective study • Missing data (difficulty to obtain detailed information due to the critical situation in the Region) • The follow up is still too short compared to the course of the disease Grasselli et al., JAMA April 2020

  32. Slide 32: Conclusions

    Conclusions • In this case series of critically ill patients admitted to ICUs in Lombardy with laboratory-confirmed COVID-19: ̶ the majority of patients were older males ̶ a large proportion required mechanical ventilation and relatively high levels of PEEP ̶ ICU mortality was 26% Grasselli et al.,

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