Joo, ja kaikilla tutkimuksilla on aina puutteensa. Täydellistä ei olekaan. Alla kuitenkin lisää hengityskonepotilaiden kuolleisuudesta. Valitettavasti nämä eivät ihan kauheasti paranna tuota kuvaa, joka ainakin näyttäisi siltä, että melko huono ennuste on hengityskonepotilailla. Tähän olisi kyllä mielenkiintoista saada lisää tuoretta dataa.
https://www.thelancet.com/action/showPdf?pii=S2213-2600(20)30079-5
Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study
In this single-centered, retrospective, observational study, we enrolled 52 critically ill adult patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital (Wuhan, China) - - - The mean age of the 52 patients was 59·7 (SD 13·3) years, 35 (67%) were men, 21 (40%) had chronic illness - - - The mortality of critically ill patients with SARS-CoV-2 pneumonia is considerable. The survival time of the non-survivors is likely to be within 1–2 weeks after ICU admission.- - - Critically ill patients were defined as those admitted to the intensive care unit (ICU) who required mechanical ventilation or had a fraction of inspired oxygen (FiO2) of at least 60% or more.
30 (81%) of 37 patients requiring mechanical ventilation had died by 28 days. - - - Of the 20 patients who survived, eight patients were discharged. Three patients were still on invasive ventilation at 28 days, including one patient who was also on ECMO. One patient was on non-invasive ventilation, two were using high-flow nasal cannula, and six were using common nasal cannula.
Like SARS-CoV and Middle Eastern respiratory syndrome (MERS)-CoV, SARS-CoV-2 is a coronavirus that can be transmitted to humans, and these viruses are all related to high mortality in critically ill patients. However, the mortality rate in patients with SARS-CoV-2 infection in our cohort is higher than that previously seen in critically ill patients with SARS.
In conclusion, the mortality of critically ill patients with SARS-CoV-2 pneumonia is high. The survival term of the non-survivors is likely to be within 1–2 weeks after ICU admission. Older patients (>65 years) with comorbidities and ARDS are at increased risk of death. The severity of SARS-CoV-2 pneumonia poses great strain to hospital critical care resources, especially if they are not adequately staffed or resourced. (Lihavoinnit tässä)
https://www.thelancet.com/action/showPdf?pii=S2213-2600(20)30110-7
Respiratory support for patients with COVID-19 infection
The ICU mortality rate among those who required non- invasive ventilation was 23 (79%) of 29 and among those who required invasive mechanical ventilation was19 (86%) of 22. (Tässä viitataan edelliseen tutkimukseen, lihavointi tässä)
Non-invasive ventilation is not recommended for patients with viral infections complicated by pneumonia because, although non-invasive ventilation temporarily improves oxygenation and reduces the work of breathing in these patients, this method does not necessarily change the natural disease course.
Finally, the application of non- invasive ventilation in patients with COVID-19 in the ICU is controversial. Considering the above factors, clinicians might not use non-invasive ventilation for critically ill patients with ARDS due to COVID-19 until further data from the COVID-19 epidemic are available.