Very severe COVID-19 in the critically ill in Tunisia

• Published in: The Pan African medical journal Vol. 35; no. Suppl 2; p. 136
• Main Authors: Saida, Imen Ben, Ennouri, Emna, Nachi, Rayane, Meddeb, Khaoula, Mahmoud, Jihene, Thabet, Nesrine, Jerbi, Salma, Boussarsar, Mohamed
• Format: Journal Article
• Language: English
• Published: Uganda 2020
• Subjects: Antiviral Agents - therapeutic use; Betacoronavirus; Cardiovascular Diseases - epidemiology; Comorbidity; Coronavirus Infections - drug therapy; Coronavirus Infections - epidemiology; COVID-19; Critical Illness - epidemiology; Delirium - etiology; Diabetes Mellitus - epidemiology; Female; Hospital Mortality; Hospitals, Teaching - statistics & numerical data; Humans; Hydroxychloroquine - therapeutic use; Male; Middle Aged; Obesity - epidemiology; Pandemics; Pneumonia, Viral - drug therapy; Pneumonia, Viral - epidemiology; Prognosis; Renal Insufficiency, Chronic - epidemiology; Respiration, Artificial - statistics & numerical data; Respiratory Distress Syndrome - etiology; Retrospective Studies; SARS-CoV-2; Simplified Acute Physiology Score; Tunisia - epidemiology; Tunisia; COVID-19; acute respiratory distress syndrome; SARS-CoV-2; pneumonia
• ISSN: 1937-8688; 1937-8688
• DOI: 10.11604/pamj.supp.2020.35.2.24753

SARS-CoV-2 is an emerging health threat outbreak. It may cause severe viral pneumonia with Acute Respiratory Distress Syndrome requiring critical care. Aim: to describe clinical features and outcomes of critically ill patients with SARS-CoV-2 infection. it was a retrospective study carried out in the medical ICU of Farhat Hached teaching hospital between March 11 and May 7, 2020. All consecutive patients with RT-PCR confirmed COVID-19 were included. Clinical characteristics and outcomes were collected by reviewing medical records. during the study period, 10 critically ill patients with COVID-19 were enrolled. Mean age, 51.8±6.3 years; 8(80%), male. The most common comorbidities were; diabetes mellitus, 6(60%), obesity 2(20%), chronic kidney disease 2(20%) and hypertension 1(10%). Mean SAPS II, 23.2±1.8. The mean arterial oxygen partial pressure to fractional inspired oxygen ratio at admission was 136.2±79.7. Noninvasive mechanical ventilation was used in 4(40%) patients and 7(70%) received invasive mechanical ventilation. Tidal volume and PEEP were set respectively within the median [IQR] of, 5.7[5.6-6.3]ml/Kg and 10.7[6.5-11.7]cm H O. Plateau pressure was monitored in the median [IQR] of 27.9 [25.9-28.5] cm H O. Four patients received hydroxychloroquine alone and five hydroxychloroquine associated with an antiviral. Five patients developed respectively hyperactive (n=2), hypoactive (n=2) and mixed delirium (n=1). Mortality rate was at 70%. this study demonstrated a particular profile of COVID-19 in the critically ill as a severe presentation in aged males with comorbidities presenting with an ARDS-like and neurological impairment with poor prognosis. The only survivals seem to have benefited from noninvasive ventilatory support.