Koronaviruspandemiaan liittynyt tehohoidon tarve ja hoitotulokset Suomessa kevään ja kesän 2020 aikana

Vertaisarvioitu.COVID-19-pandemia aiheutti merkittävää tehohoidon tarvetta keväällä 2020. Tilannekuvaa kokoamaan perustettiin tehohoidon koordinoiva toimisto, joka raportoi viranomaisille ajantasaista tietoa potilas- ja paikkamääristä koko maassa. Suurin tehohoidon kuormitus kohdistui HUS:n sairaaloihin. Teho-osastoilla hoidettiin yhteensä 227:ää COVID-19-potilasta, ja erillisiä tehohoitojaksoja kirjattiin 293. Suomessa COVID-19-potilaiden tehohoitokuolleisuus oli vähäistä, vain 15 %. Ikä ja krooniset sairaudet lisäsivät kuolleisuutta. Tehohoitojaksot olivat tavanomaisia tehohoitojaksoja pidempiä (14 vrk vs 3 vrk), ja 67 % potilaista tarvitsi hengityslaitehoitoa. Epidemian vaikeimmassa vaiheessa huhtikuun puolivälissä tehohoitokapasiteettia oli jo kasvatettu voimakkaasti, ja sen täyttöaste jäi alle puoleen.Peer reviewe

Association between first language and SARS-CoV-2 infection rates, hospitalization, intensive care admissions and death in Finland : a population-based observational cohort study

Funding Information: VH has received a grant from Finska L?kares?llskapet. AJ has received a grant from Wilhelm och Else Stockmanns stiftelse and speaker honoraria from Astellas, GlaxoSmithKline, Sanofi, Thermo Fisher, MSD, OrionPharma and UnimedicPharma. JH has recieved grants from NordForsk, Government research funding and Kirsti och Tor Johansson's hj?rt och cancerstiftelse. The authors declare that they have no other conflicts of interest in relation to this work. This work was supported by a research grant from Finska L?kares?llskapet. Funding Information: VH has received a grant from Finska Läkaresällskapet . AJ has received a grant from Wilhelm och Else Stockmanns stiftelse and speaker honoraria from Astellas , GlaxoSmithKline , Sanofi , Thermo Fisher , MSD , OrionPharma and UnimedicPharma . JH has recieved grants from NordForsk , Government research funding and Kirsti och Tor Johansson’s hjärt och cancerstiftelse . The authors declare that they have no other conflicts of interest in relation to this work. This work was supported by a research grant from Finska Läkaresällskapet . Publisher Copyright: © 2021 The AuthorsObjectives: Motivated by reports of increased risk of coronavirus disease 2019 (COVID-19) in ethnic minorities of high-income countries, we explored whether patients with a foreign first language are at an increased risk of COVID-19 infections, more serious presentations, or worse outcomes. Methods: In a retrospective observational population-based quality registry study covering a population of 1.7 million, we studied the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), admissions to specialist healthcare and the intensive care unit (ICU), and all-cause case fatality in different language groups between 27th February and 3rd August 2020 in Southern Finland. A first language other than Finnish, Swedish or Sami served as a surrogate marker for a foreign ethnic background. Results: In total, 124 240 individuals were tested, and among the 118 300 (95%) whose first language could be determined, 4005 (3.4%) were COVID-19-positive, 623 (0.5%) were admitted to specialized hospitals, and 147 (0.1%) were admitted to the ICU; 254 (0.2%) died. Those with a foreign first language had lower testing rates (348, 95%CI 340-355 versus 758, 95%CI 753-762 per 10 000, p < 0.0001), higher incidence (36, 95%CI 33-38 versus 22, 95%CI 21-23 per 10 000, p < 0.0001), and higher positivity rates (103, 95%CI 96-109 versus 29, 95%CI 28-30 per 1000, p < 0.0001). There was no significant difference in ICU admissions, disease severity at ICU admission, or ICU outcomes. Case fatality by 90 days was 7.7% in domestic cases and 1.2% in those with a foreign first language, explained by demographics (age-and sex adjusted HR 0.49, 95%CI 0.21-1.15). Conclusions: The population with a foreign first language was at an increased risk for testing positive for SARS-CoV-2, but when hospitalized they had outcomes similar to those in the native, domestic language population. This suggests that special attention should be paid to the prevention and control of infectious diseases among language minorities. (C) 2021 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.Peer reviewe

Lung function and exercise capacity 6 months after hospital discharge for critical COVID-19

Background The significant morbidity caused by COVID-19 necessitates further understanding of long-term recovery. Our aim was to evaluate long-term lung function, exercise capacity, and radiological findings in patients after critical COVID-19. Methods Patients who received treatment in ICU for COVID-19 between March 2020 and January 2021 underwent pulmonary function tests, a 6MWD and CXR 6 months after hospital discharge. Results A restrictive ventilatory defect was found in 35% (23/65) and an impaired diffusing capacity in 52% (32/62) at 6 months. The 6-minute walk distance was reduced in 33% (18/55), and 7% (4/55) of the patients had reduced exercise capacity. Chest X-ray was abnormal in 78% (52/67) at 6 months after hospital discharge. Conclusion A significant number of patients had persisting lung function impairment and radiological abnormalities at 6 months after critical COVID-19. Reduced exercise capacity was rare.Peer reviewe

A descriptive study of the surge response and outcomes of ICU patients with COVID-19 during first wave in Nordic countries

Abstract Background We sought to provide a description of surge response strategies and characteristics, clinical management and outcomes of patients with severe COVID-19 in the intensive care unit (ICU) during the first wave of the pandemic in Denmark, Finland, Iceland, Norway and Sweden. Methods Representatives from the national ICU registries for each of the five countries provided clinical data and a description of the strategies to allocate ICU resources and increase the ICU capacity during the pandemic. All adult patients admitted to the ICU for COVID-19 disease during the first wave of COVID-19 were included. The clinical characteristics, ICU management and outcomes of individual countries were described with descriptive statistics. Results Most countries more than doubled their ICU capacity during the pandemic. For patients positive for SARS-CoV-2, the ratio of requiring ICU admission for COVID-19 varied substantially (1.6-6.7%). Apart from age (proportion of patients aged 65 years or over between 29-62%), baseline characteristics, chronic comorbidity burden and acute presentations of COVID-19 disease were similar among the five countries. While utilization of invasive mechanical ventilation was high (59-85%) in all countries, the proportion of patients receiving renal replacement therapy (7-26%) and various experimental therapies for COVID-19 disease varied substantially (e.g. use of hydroxychloroquine 0-85%). Crude ICU mortality ranged from 11% to 33%. Conclusion There was substantial variability in the critical care response in Nordic ICUs to the first wave of COVID-19 pandemic, including usage of experimental medications. While ICU mortality was low in all countries, the observed variability warrants further attention.Peer reviewe

Lung function and exercise capacity 6 months after hospital discharge for critical COVID-19

Background The significant morbidity caused by COVID-19 necessitates further understanding of long-term recovery. Our aim was to evaluate long-term lung function, exercise capacity, and radiological findings in patients after critical COVID-19. MethodsPatients who received treatment in ICU for COVID-19 between March 2020 and January 2021 underwent pulmonary function tests, a 6MWD and CXR 6 months after hospital discharge. ResultsA restrictive ventilatory defect was found in 35% (23/65) and an impaired diffusing capacity in 52% (32/62) at 6 months. The 6-minute walk distance was reduced in 33% (18/55), and 7% (4/55) of the patients had reduced exercise capacity. Chest X-ray was abnormal in 78% (52/67) at 6 months after hospital discharge. ConclusionA significant number of patients had persisting lung function impairment and radiological abnormalities at 6 months after critical COVID-19. Reduced exercise capacity was rare.</p