Covid-19, the profile of intensive care patients becomes clearer



In recent days, the counter has been going crazy: the number of people with Covid-19 hospitalized in intensive care has continued to climb. Tuesday, November 3, they were 3,869 in France. Who are these patients? What clinical characteristics do they present? A study, carried out between February 25 and May 4 in 149 intensive care units in France, Belgium and Switzerland, helps to better understand the profile of the most serious Covid-19 cases.

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Published in the journal Intensive Care Medicine, it shows the 90-day evolution of 4,244 patients with acute respiratory distress syndrome. “It’s a retrospective analysis of the data collected during this period, explains Professor Jean-Michel Constantin, head of the resuscitation service at Pitié-Salpêtrière, who took part in the study. She confirms to us what we knew already: Covid-19 is a very serious disease that can have an appalling impact on people’s lives. “

Decreasing mortality

This photograph taken over three months provides statistics impossible to establish in real time. The study shows that nearly seven out of ten people left their hospitalization in intensive care alive. The death rate, 31% over 90 days, decreased over the observed period from 42 to 25%, without a precise explanation being able to be brought to light.

“We can think that this decrease is due to a better understanding of the disease, indicates Professor Jean-Michel Constantin. At the beginning, for example, several of our patients had pulmonary embolisms. We understood that it was necessary to strengthen the anticoagulation. We also used more corticosteroids that were proven to work. Finally, we try, when possible, to avoid early intubations, which are difficult for the patient to bear. In total, 80% of the cohort was intubated, including 63% of patients upon admission to intensive care.

Improve practices

The study, which focuses on the most severe cases, also recalls which populations are most at risk. With a median age of 63 years, 74% of the patients then hospitalized were men. 41% of them were overweight, with a body mass index greater than or equal to 30 kg / m2 (1). 48% suffered from high blood pressure and 28% from diabetes.

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Aggravating factors still observed. “This study presents results similar to others recently published in Holland or the United States, specifies Professor Jean-Michel Constantin. For us, it is very valuable to be able to cross-check our information. We learned, for example, that a majority of people over 80 who are intubated die. For them, for their families, there is no benefit! Less invasive techniques should therefore be favored in these cases. The more we advance, the more we question our practices. »An essential questioning in the face of a second wave announced as even more deadly than the first.

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