Background The novel coronavirus (2019-nCOV) appeared in China and precipitously extended across the globe. As always, natural disasters or infectious disease outbreaks have the potential to cause emergency department (ED) volume changes. Objective We aimed to assess the influence of the Coronavirus Disease 2019 (COVID-19) pandemic on ED visits and the impact on the handling of patients requiring urgent revascularization. Methods We reviewed the charts of all patients presenting to the ED of Hospital Sainte Anne (Toulon, France) from March 23 to April 5, 2020 and compared them with those of the same period in 2019. Then we analyzed complementary data on acute coronary syndrome (ST-elevation myocardial infarction [STEMI] and non-ST-elevation myocardial infarction [NSTEMI]) and neurovascular emergencies (strokes and transient ischemic attacks). Results The total number of visits decreased by 47%. The number of people assessed as triage level 2 was 8% lower in 2020. There were five fewer cases of NSTEMI in 2020, but the same number of STEMI. The number of neurovascular emergencies increased (27 cases in 2019 compared with 30 in 2020). We observed a reduction in the delay between arrival at the ED and the beginning of coronary angiography for STEMI cases (27 min in 2019 and 22 min in 2020). In 2020, 7 more stroke patients were admitted. Conclusion The COVID-19 pandemic probably dissuaded “non-critical” patients from coming to the hospital, whereas the same number of patients with a critical illness attended the ED as attended prior to the pandemic. There does not seem to have been any effect of the pandemic on patients requiring reperfusion therapy (STEMI and stroke).

Background: High incidence of ventilator associated pneumonia (VAP) has been reported in critically ill patients with COVID-19. Among these patients, we aimed to assess the incidence, outcomes and risk factors of VAP recurrences. Methods: We conducted an observational retrospective study in three French intensive care units (ICUs). Patients admitted for a documented COVID-19 from March 2020 to May 2021 and requiring mechanical ventilation (MV) for ≥48 h were included. The study main outcome was the incidence of VAP recurrences. Secondary outcomes were the duration of MV, ICU and hospital length of stay and mortality according to VAP and recurrences. We also assessed the factors associated with VAP recurrences. Results: During the study period, 398 patients met the inclusion criteria. A total of 236 (59%) of them had at least one VAP episode during their ICU stay and 109 (46%) of these patients developed at least one recurrence. The incidence of VAP recurrence considering death and extubation as competing events was 29.6% (IC = [0.250–0.343]). Seventy-eight percent of recurrences were due to the same bacteria (relapses). Patients with a VAP recurrence had a longer duration of MV as compared with one VAP and no VAP patients (41 (25–56) vs. 16 (8–30) and 10 (5–18) days; p < 0.001) and a longer ICU length of stay (46 (29–66) vs. 22 (12–36) and 14 (9–25) days; p < 0.001). The 90-day mortality was higher in the recurrence group as compared with the no VAP group only (31.2 vs. 21.0% (p = 0.021)). In a multivariate analysis including bacterial co-infection at admission, the use of immunosuppressive therapies and the bacteria responsible for the first VAP episode, the duration of MV was the only factor independently associated with VAP recurrence. Conclusion: In COVID-19 associated respiratory failure, recurrences affected 46% of patients with a first episode of VAP. VAP recurrences were mainly relapses and were associated with a prolonged duration of MV and ICU length of stay but not with a higher mortality. MV duration was the only factor associated with recurrences.

Objectives: To describe clinical characteristics and management of intensive care units (ICU) patients with laboratory-confirmed COVID-19 and to determine 90-day mortality after ICU admission and associated risk factors. Methods: This observational retrospective study was conducted in six intensive care units (ICUs) in three university hospitals in Marseille, France. Between 10 March and 10 May 2020, all adult patients admitted in ICU with laboratory-confirmed SARS-CoV-2 and respiratory failure were eligible for inclusion. The statistical analysis was focused on the mechanically ventilated patients. The primary outcome was the 90-day mortality after ICU admission. Results: Included in the study were 172 patients with COVID-19 related respiratory failure, 117 of whom (67%) received invasive mechanical ventilation. 90-day mortality of the invasively ventilated patients was 27.4%. Median duration of ventilation and median length of stay in ICU for these patients were 20 (9–33) days and 29 (17–46) days. Mortality increased with the severity of ARDS at ICU admission. After multivariable analysis was carried out, risk factors associated with 90-day mortality were age, elevated Charlson comorbidity index, chronic statins intake and occurrence of an arterial thrombosis. Conclusion: In this cohort, age and number of comorbidities were the main predictors of mortality in invasively ventilated patients. The only modifiable factor associated with mortality in multivariate analysis was arterial thrombosis.

IntroductionThe aim of this study was to evaluate if an automated measurement of lung lesions, epicardial fat and pericardial volume during the days surrounding hospital admission for COVID-19 pneumonia may predict intubation or mortality. The second purpose of this study was to assess whether the association of these Computed Tomography (CT) measures with the SOFA (Sequential Organ Failure Assessment) score, could predict intubation and mortality better than the SOFA score alone.MethodsThis observational retrospective study was conducted in Timone university hospital in Marseille in France, between March 10th and May 10th 2020. All adult patients with COVID-19, admitted with respiratory symptoms and having performed a chest CT three days before to two days after admission were eligible for inclusion. All chest CTs were analyzed using a local automated CT measurement software. The primary outcome was invasive mechanical ventilation (IMV) or death during the 60-day follow-up. Wilcoxon-Mann-Whitney test was used for univariate analysis and logistic regression were calculated for multivariate analysis. Results176 patients were included in the study. 57 (32.4%) received IMV or died during the 60-day follow-up. After univariate analysis, all lung automated volumetric measures of ground-glass (p=0.015), consolidation (p<0.001) and all lesions to parenchymal volume ratio (p<0.001) were significantly higher for the patients who required IMV or who died. All pulmonary-lesion rate was tested in multivariate analysis and remained significantly higher in the IMV or death group (p=0.003), with an Odd Ratio of 3.52 (1.55-8.01, 95% CI) for patients who had more than 19.5% of pulmonary lesion. Pericardial volume and epicardial fat were not significantly associated with IMV or mortality. In this study, the association of the criterion “pulmonary lesion >20%” to the SOFA score improves its predictive value on IMV or mortality with a AUC of 0.82.ConclusionAutomated chest CT measures of COVID-19 patients with respiratory symptoms admitted to hospital showed a significantly higher rate of lung lesions (ground glass, consolidation, or both) for those who later died or required IMV. Furthermore, the association of these automated CT measures to the SOFA score could help select patients requiring ICU upon entering hospital.