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Le coronavirus du syndrome respiratoire aigu severe 2 (SRAS-CoV-2) est responsable de la maladie a coronavirus 2019 (COVID-19), qui a maintenant le statut de pandemie selon l'Organisation mondiale de la [...], CONTEXTE : La pandemie de maladie a coronavirus du syndrome respiratoire aigu severe 2 (SRAS-CoV-2) est associee a une mortalite elevee dans les unites de soins intensifs (USI). Nous avons voulu decrire les caracteristiques cliniques et les issues des patients gravement atteints de la maladie a coronavirus 2019 (COVID-19) en contexte canadien. METHODES : Nous avons procede a l'etude retrospective d'une serie de cas graves d'infection au SRAS-CoV-2 confirmee en laboratoire hospitalises dans l'une des 6 USI du Vancouver metropolitain, en Colombie-Britannique (Canada), entre le 21 fevrier et le 14 avril 2020. Les donnees demographiques, les renseignements sur la prise en charge et les resultats ont ete recueillis a partir des dossiers medicaux, electroniques ou non, des patients. RESULTATS : Entre le 21 fevrier et le 14 avril 2020, 117 patients ont ete admis dans une USI avec un diagnostic confirme de COVID-19. L'age median etait de 69 ans (ecart interquartile [EI] 60-75 ans); et 38 (32,5 %) etaient des femmes. Au moins une comorbidite etait presente chez 86 patients (73,5 %). La ventilation mecanique a ete necessaire chez 74 patients (63,2 %). La duree de la ventilation mecanique a ete de 13,5 jours (EI 8-22 jours) dans l'ensemble et de 11 jours (II 6-16) chez les patients qui ont recu leur conge de l'USI. Du tocilizumab a ete administre a 4 patients et de l'hydroxychloroquine a 1 patient. En date du 5 mai 2020, 18 patients (15,4 %) etaient decedes, 12 (10,3 %) etaient toujours a l'USI, 16 (13,7 %) avaient obtenu leur conge de l'USI, mais restaient hospitalises, et 71 (60,7 %) avaient pu retourner a la maison. INTERPRETATION : Dans cette etude, la mortalite chez les patients gravement malades de la COVID-19 hospitalises dans une USI a ete moins elevee que chez les patients d'etudes precedentes. Ces resultats donnent a penser que le pronostic des cas graves de COVID-19 pourrait ne pas etre aussi sombre que ce qui avait d'abord ete rapporte.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), now characterized as a pandemic by the World Health Organization. (1) Infection rates and deaths worldwide increased exponentially. [...], BACKGROUND: Pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with high intensive care unit (ICU) mortality. We aimed to describe the clinical characteristics and outcomes of critically ill patients with coronavirus disease 2019 (COVID-19) in a Canadian setting. METHODS: We conducted a retrospective case series of critically ill patients with laboratory-confirmed SARS-CoV-2 infection consecutively admitted to 1 of 6 ICUs in Metro Vancouver, British Columbia, Canada, between Feb. 21 and Apr. 14, 2020. Demographic, management and outcome data were collected by review of patient charts and electronic medical records. RESULTS: Between Feb. 21 and Apr. 14, 2020, 117 patients were admitted to the ICU with a confirmed diagnosis of COVID-19. The median age was 69 (interquartile range [IQR] 60-75) years, and 38 (32.5%) were female. At least 1 comorbidity was present in 86 (73.5%) patients. Invasive mechanical ventilation was required in 74 (63.2%) patients. The duration of mechanical ventilation was 13.5 (IQR 8-22) days overall and 11 (IQR 6-16) days for patients successfully discharged from the ICU. Tocilizumab was administered to 4 patients and hydroxychloroquine to 1 patient. As of May 5, 2020, a total of 18 (15.4%) patients had died, 12 (10.3%) remained in the ICU, 16 (13.7%) were discharged from the ICU but remained in hospital, and 71 (60.7%) were discharged home. INTERPRETATION: In our setting, mortality in critically ill patients with COVID-19 admitted to the ICU was lower than in previously published studies. These data suggest that the prognosis associated with critical illness due to COVID-19 may not be as poor as previously reported.

Purpose: Targeted blood pressure thresholds remain unclear in critically ill patients. Two prior systematic reviews have not shown differences in mortality with a high mean arterial pressure (MAP) threshold, but there have been new studies published since. Thus, we conducted an updated systematic review and meta-analysis of randomized controlled trials (RCTs) that compared the effect of a high–normal vslow–normal MAP on mortality, favourable neurologic outcome, need for renal replacement therapy, and adverse vasopressor-induced events in critically ill patients. Source: We searched six databases from inception until 1 October 2022 for RCTs of critically ill patients targeted to either a high–normal vsa low–normal MAP threshold for at least 24 hr. We assessed study quality using the revised Cochrane risk-of-bias 2 tool and the risk ratio (RR) was used as the summary measure of association. We used the Grading of Recommendations Assessment, Development, and Evaluation framework to assess the certainty of evidence. Principal findings: We included eight RCTs with 4,561 patients. Four trials were conducted in patients following out-of-hospital cardiac arrest, two in patients with distributive shock requiring vasopressors, one in patients with septic shock, and one in patients with hepatorenal syndrome. The pooled RRs for mortality (eight RCTs; 4,439 patients) and favourable neurologic outcome (four RCTs; 1,065 patients) were 1.06 (95% confidence interval [CI], 0.99 to 1.14; moderate certainty) and 0.99 (95% CI, 0.90 to 1.08; moderate certainty), respectively. The RR for the need for renal replacement therapy (four RCTs; 4,071 patients) was 0.97 (95% CI, 0.87 to 1.08; moderate certainty). There was no statistical between-study heterogeneity across all outcomes. Conclusion: This updated systematic review and meta-analysis of RCTs found no differences in mortality, favourable neurologic outcome, or the need for renal replacement therapy between critically ill patients assigned to a high–normal vslow–normal MAP target. Study registration: PROSPERO (CRD42022307601); registered 28 February 2022.