French multicentre observational study on SARS-CoV-2 infections intensive care initial management: the FRENCH CORONA study

Claire Roger (1, 2) , Olivier Collange (3, 4) , Myriam Mezzarobba (1, 5) , Osama Abou-Arab (6) , Lauranne Teule (7) , Marc Garnier (8, 9) , Clément Hoffmann (10) , Laurent Muller (1, 2) , Jean-Yves Lefrant (1, 2) , Pierre-Grégoire Guinot (11) , Emmanuel Novy (12) , Paul Abraham (13, 14) , Thomas Clavier (15, 16) , Jérémy Bourenne (17) , Guillaume Besch (18, 19) , Laurent Favier (20) , Michel Fiani , Alexandre Ouattara (21, 22) , Olivier Joannes-Boyau (21, 22) , Marc-Olivier Fischer (23, 24) , Marc Leone (25, 26, 27) , Younes Ait Tamlihat , Julien Pottecher (4, 28, 29) , Pierre-Yves Cordier (30) , Philippe Aussant (31) , Mouhamed Djahoum Moussa (32) , Etienne Hautin (33, 34) , Marine Bouex (35) , Jean-Michel Julia (36) , Julien Cady (37) , Marc Danguy Des Deserts (38) , Nicolas Mayeur (39) , Thibault Mura (1) , Bernard Allaouchiche (40)

1 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
2 IMAGINE - Initial MAnagement and prevention of acute orGan failures IN critically ill patiEnts
3 Nouvel Hôpital Civil de Strasbourg
4 HUS - Les Hôpitaux Universitaires de Strasbourg
5 UM - Université de Montpellier
6 CHU Amiens-Picardie
7 Centre Hospitalier Saint Jean de Perpignan
8 GRC 29 - ARPE - Groupe de Recherche Clinique en Anesthésie Réanimation médecine PEriopératoire
9 CHU Saint-Antoine [AP-HP]
10 Hôpital d'instruction des Armées Percy
11 Service d'anesthésie - réanimation chirurgicale [CHU de Dijon]
12 Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy]
13 HCL - Hospices Civils de Lyon
14 Hôpital Edouard Herriot [CHU - HCL]
15 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
16 CHU Rouen
17 TIMONE - Hôpital de la Timone [CHU - APHM]
18 PCVP / CARDIO - Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920)
19 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
20 CH Béziers
21 CHU Bordeaux
22 Centre médico chirurgical Magellan - Hôpital Haut-Lévêque - CHU de Bordeaux
23 Service d'Anesthésie - Réanimation Chirurgicale [CHU Caen]
24 NU - Normandie Université
25 Hôpital Nord [CHU - APHM]
26 AMU - Aix Marseille Université
27 MEPHI - Microbes évolution phylogénie et infections
28 MSP - Mitochondrie, Stress oxydant et Protection musculaire
29 FMTS - Fédération de Médecine Translationnelle de Strasbourg
30 Hôpital d'Instruction des Armées Laveran
31 Centre hospitalier Robert Brisson [Lisieux]
32 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
33 Ramsay Santé
34 Clinique de la Sauvegarde [Lyon]
35 CHAC - Centre Hospitalier Alès-Cévennes
36 CRP Clinique du Parc, Castelnau-Le-Lez
37 Institut Arnault Tzanck
38 Hôpital d'Instruction des Armées Clermont Tonnerre
39 Clinique Pasteur [Toulouse]
40 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]

Aim: Describing acute respiratory distress syndrome patterns, therapeutics management, and outcomes of ICU COVID-19 patients and indentifying risk factors of 28-day mortality.Methods: Prospective multicentre, cohort study conducted in 29 French ICUs. Baseline characteristics, comorbidities, adjunctive therapies, ventilatory support at ICU admission and survival data were collected.Results: From March to July 2020, 966 patients were enrolled with a median age of 66 (interquartile range 58-73) years and a median SAPS II of 37 (29-48). During the first 24 h of ICU admission, COVID-19 patients received one of the following respiratory supports: mechanical ventilation for 559 (58%), standard oxygen therapy for 228 (24%) and high-flow nasal cannula (HFNC) for 179 (19%) patients. Overall, 721 (75%) patients were mechanically ventilated during their ICU stay. Prone positioning and neuromuscular blocking agents were used in 494 (51%) and 460 (48%) patients, respectively. Bacterial co-infections and ventilator-associated pneumonia were diagnosed in 79 (3%) and 411 (43%) patients, respectively. The overall 28-day mortality was 18%. Age, pre-existing comorbidities, severity of respiratory failure and the absence of antiviral therapy on admission were identified as independent predictors of 28-day outcome.Conclusion: Severity of hypoxaemia on admission, older age (> 70 years), cardiovascular and renal comorbidities were associated with worse outcome in COVID-19 patients. Antiviral treatment on admission was identified as a protective factor for 28-day mortality. Ascertaining the outcomes of critically ill COVID-19 patients is crucial to optimise hospital and ICU resources and provide the appropriate intensity level of care.

Mots clés: COVID-19; Management; Outcome; Viral pneumonia

Domaines: Médecine humaine et pathologie

Claire Roger, Olivier Collange, Myriam Mezzarobba, Osama Abou-Arab, Lauranne Teule, et al.. French multicentre observational study on SARS-CoV-2 infections intensive care initial management: the FRENCH CORONA study. Anaesthesia Critical Care & Pain Medicine, 2021, 40 (4), pp.100931. ⟨10.1016/j.accpm.2021.100931⟩. ⟨hal-03632626⟩