Ahigh Mortality Research Articles

ERNICA Evidence Based Guideline on Surgical Aspects of Necrotizing Enterocolitis in Premature Neonates

Background Necrotizing enterocolitis (NEC) is a severe intestinal condition primarily affecting preterm neonates. It has ahigh mortality rate, particularly in infants with a birth weight of below 1500 grams or for those requiring surgical intervention. The European Reference Network for Inherited and Congenital Anomalies (ERNICA) has developed a clinical practice guideline to aid clinical decision-making pertaining to the surgical treatment and management of NEC in preterm neonates. Summary This guideline was developed in accordance with the Guidelines 2.0 checklist and GRADE methodology. A multidisciplinary group of Europe’s top experts collaborated with patient representatives to develop this guideline. After selecting critical points in care for which recommendations are required, a systematic review of the literature and critical appraisal of the evidence was performed. The Evidence to Decision framework was used as a guide to structure the consensus meetings and draft the recommendations. The panel developed seven recommendations and three good-practice statements on the following topics: indications for surgery, peritoneal drainage, surgical technique, management of extensive NEC, enteral feeding and neurodevelopmental outcomes in premature neonates with NEC. The certainty of evidence was graded as (very) low for most recommendations. However, the panel weighed up the benefits and harms in light of all relevant arguments and expert opinion. Key Messages This guideline provides recommendations on caring for premature neonates with NEC. These recommendations can assist clinicians in their care decisions and can inform families on treatment options and relevant considerations. This guideline will be revised every five years to ensure it remains up to date.

Evaluation ofcoagulation bythromboelastography and avelocity curve indogs with parvoviral enteritis.

Canine parvoviral enteritis (CPE) has ahigh mortality rate inuntreated dogs due tosystemic inflammation and multi-organ dysfunction. The inflammatory process can lead tocoagulation abnormalities. This study aimed toevaluate the coagulation status using thromboelastography (TEG) and assess the thrombin generation (TG) and clot dissolution using TEG-derived velocity curve (v-curve) parameters indogs with CPE. Itincluded 21dogs with CPE and five healthy dogs. Inaddition tothe clinico-haemato-biochemical examinations, the coagulation status was analysed using citrated venous blood samples with TEG. All the dogs with CPE met atleast two criteria for systemic inflammatory response syndrome (SIRS). The comparison tohealthy controls showed astatistically significant prolongation ofreaction times (Rtime; P=0.005) and times tothe maximum rate ofthrombus generation (TMRTG; P=0.003). However, the times tothe maximum rate oflysis (TMRL; P=0.041) and total lysis (L; P=0.024) decreased significantly. The TEG tracings showed coagulation states varying from hypocoagulation tohypercoagulation indogs with CPE. These results showed that the v-curve derivate can beused toevaluate the coagulation indogs with CPE, and itcould besuperior tothe standard TEG variables for determining the low fibrinolytic activity. Thus, the v-curve parameters may provide anovel insight into the underlying mechanism and clinical treatment strategy ofCPE-induced inflammation.

Abdominal compartment syndrome in visceral surgery and intensive care medicine : Causes, prevention, detection, treatment

An increased intra-abdominal pressure can result in amanifest abdominal compartment syndrome (ACS) with significant organ damage, which is a life-threatening situation associated with ahigh mortality. Although the etiology is manifold and critically ill patients on the intensive care unit are particularly endangered, the disease is often not diagnosed even though the measurement of bladder pressure is available as a simple and standardized method; however, particularly the early detection of an increased intra-abdominal pressure is decisive in order to prevent the occurrence of a manifest ACS with (multi)organ failure by means of conservative measures. In cases of a conservative refractory situation, decompressive laparotomy is indicated.

Extracorporeal cardiopulmonary resuscitation-An orientation

Both in-hospital and out-of-hospital cardiac arrests are associated with ahigh mortality. In the past survival advantages for patients could be achieved by optimizing the chain of rescue and postresuscitation treatment; however, for patients with refractory cardiac arrest, there have so far been few promising treatment options. For selected patients with refractory cardiac arrest who do not achieve return of spontaneous circulation with conventional cardiopulmonary resuscitation (CPR), extracorporeal (e)CPR using venoarterial extracorporeal membrane oxygenation is an option to improve the probability of survival. This article describes the technical features, important aspects of treatment, and the current data situation on eCPR in patients with in-hospital or out-of-hospital cardiac arrest.

Abstract 16187: COVID-19 and Outcomes of Acute Ischemic Stroke - A Nationwide Cross-Sectional Study

Introduction: Acute ischemic stroke (AIS) is thesecond leading cause of death globally, accounting for approximately 11% of alldeaths, long-term disability, and functional impairments in survivors. TheCOVID-19 pandemic has raised concerns about its impact on AIS patients. Aim: This study aimed to assess the outcomes,including mortality and severity of disability in AIS hospitalizations withCOVID-19. Methods: We performed a retrospective cross-sectionalanalysis of the Nationwide Inpatient Sample (NIS-2020) in adulthospitalizations for AIS to compare the outcomes [death & APRDRGseverity/disability] in COVID-19 patients using ICD-10 codes. We performedweighted analyses using chi-square, unpaired t-test, and multivariate logisticregression models to evaluate COVID-19-associated poor outcomes amongst AISpatients. Results: Out of 504,460 AIS patients, 7,590 had AIStriggered by COVID-19. Amongst AIS hospitalizations, COVID-19 was more frequentin age group >65 year old 63.2%, male 52.6%, White race (51.4%), patientwith Medicare (58.7%), median household income 0-25 percentile (33.6%), Southzone (43.4%), and hypertensives (83.7%). AIS patients with COVID-19 had ahigher mortality (10.93% vs 3.8%) and severe/extreme disability (93.21% vs37.43%) rates in comparison to patients without COVID-19. (p<0.0001) Inregression analysis COVID-19 was associated with 213% higher odds of mortality(aOR: 3.13, 95% CI: 2.90-3.38, p<0.0001, c:0.671) and higher odds of severe/extreme disability(26.85, 24.53-29.39, p<0.0001, c:0.686) compared to AIS patients withoutCOVID-19. Conclusion: These findings emphasize the substantialimpact of COVID-19 on AIS patients by elevating mortality and risk of severedisability compared to their counterparts. Efforts should be directed towards earlyidentification of stroke population that is at higher risk ofCOVID-19-associated poor outcome and prompt management tomitigate the burden of the both diseases.

Extracorporeal cardiopulmonary resuscitation-An orientation

Both in-hospital and out-of-hospital cardiac arrests are associated with ahigh mortality. In the past survival advantages for patients could be achieved by optimizing the chain of rescue and postresuscitation treatment; however, for patients with refractory cardiac arrest, there have so far been few promising treatment options. For selected patients with refractory cardiac arrest who do not achieve return of spontaneous circulation with conventional cardiopulmonary resuscitation (CPR), extracorporeal (e)CPR using venoarterial extracorporeal membrane oxygenation is an option to improve the probability of survival. This article describes the technical features, important aspects of treatment, and the current data situation on eCPR in patients with in-hospital or out-of-hospital cardiac arrest.

Something is up in the air: pneumothorax and pneumopericardium in a29-week preterm infant.

This report highlights the early and unusual detection of apneumopericardium by echocardiography prior to potential development of cardiocirculatory compromise. It is important to consider pneumopericardium into the differential diagnosis when difficulties arise in the visualization of the heart by conventional echocardiography. Pneumopericardium is associated with ahigh mortality rate and may be effectively treated by immediate insertion of apericardial catheter.

Anti-infective treatment of fungal infections by Candida and Aspergillus

Invasive fungal infections caused by Candida or Aspergillus are associated with ahigh mortality. Knowledge about the risk factors, diagnosis and treatment management is crucial for improving the survival of those affected. To give a practical overview about risk factors and treatment management of Candida and Aspergillus infections as well as providing an outlook on new antifungal agents. Summary of the relevant literature and recommendations on candidemia and invasive candidiasis as well as invasive and chronic pulmonary aspergillosis. The first line treatment of candidemia and invasive candidiasis are echinocandins including caspofungin, anidulafungin and micafungin. Regular blood cultures have to be taken to determine the duration of treatment. After the first negative control blood culture treatment should be continued for another 14days. The first line treatment of invasive pulmonary aspergillosis is azoles including voriconazole and isavuconazole. The duration of treatment depends on disease severity and is recommended for 6-12weeks. The duration of treatment for chronic pulmonary aspergillosis is 6-12months. Therapeutic drug monitoring is recommended for voriconazole and for posaconazole. New antifungal agents including olorofim, fosmanogepix, opelconazole, rezafungin or ibrexafungerp will broaden the therapeutic spectrum in the foreseeable future. Knowledge about risk factors and the correct treatment management is crucial for the survival of patients with invasive fungal infections.

Bilateral thoracic trauma-"double the trouble"?

Thoracic trauma is associated with a high morbidity and mortality. Assessing the risk for complications is essential for planning the further treatment strategies and managing resources in thoracic trauma. The aim of the study was to analyze concomitant injuries in unilateral and bilateral rib fractures and pulmonary contusions and evaluate differences in complication rates between the two. In aretrospective study, data from all patients diagnosed with thoracic trauma at alevelI trauma center were analyzed. Bivariate and multivariate analysis were used to examine an association of unilateral or bilateral rib fractures, serial rib fractures, and pulmonary contusions with multiple injuries and outcomes. In addition, multivariate regression analysis was utilized to determine the impact of age, gender and additional injuries on outcome. A total of 714patients were included in the analysis. The mean Injury Severity Score (ISS) was19. Patients with an additional thoracic spine injury had asignificantly higher incidence of bilateral rib fractures. Pulmonary contusions were associated with younger age. Abdominal injuries were predictors for bilateral pulmonary contusions. Complications occurred in 36% of the patients. Bilateral injuries increased the complication rate up to 70%. Pelvic and abdominal injuries as well as the need for achest drain were significant risk factors for complications. The mortality rate was 10%, with higher age, head and pelvic injuries as predictors. Patients with bilateral chest trauma had an increased incidence of complications and ahigher mortality rate. Bilateral injuries and significant risk factors must therefore be considered. Injury of the thoracic spine should be excluded in those patients.

Identification of Genes as Potential Biomarkers for Sepsis-related ARDS using Weighted Gene Co-expression Network Analysis.

Acute respiratory distress syndrome (ARDS) caused by sepsis presents a high mortality rate; therefore, identification of susceptibility genes of sepsis to ARDS at an early stage is particularly critical. The GSE66890 dataset was downloaded and analyzed by WGCNA to obtain modules. Then, GO and KEGG analyses of the module genes were performed. Then, the PPI network and LASSO model were constructed to identify the key genes. Finally, expression levels of the screened genes were validated in clinical subjects. We obtained 17 genes merged modules via WGCNA, and the dark module and tan module were the most positively and negatively correlated with sepsis-induced ARDS, respectively. Based on gene intersections of the module genes, 11 hub genes were identified in the dark module, and 5 hub genes were identified in the tan module. Finally, the six key genes were identified by constructing the LASSO model. We further detected the screened genes expression in clinical samples, and as the bioinformatics analysis revealed, the expressions of NANOG, RAC1, TWIST1, and SNW1 were significantly upregulated in the ARDS group compared to the sepsis group, and IMP3 and TUBB4B were significantly downregulated. We identified six genes as the potential biomarkers in sepsis-related ARDS. Our findings may enhance the knowledge of the molecular mechanisms behind the development of sepsisinduced ARDS.

"Stop the bleeding"-Acute bleeding control in injuries to the trunk and extremities

Trauma-related blood loss is still associated with ahigh mortality and is amajor factor in the development of adeadly triad consisting of acidosis, hypothermia and coagulopathy. Sources of bleeding occur particularly in the thoracic, abdominal and pelvic regions as well as in the extremities. For control of bleeding a timely identification of the source of bleeding and the initiation of a targeted treatment are essential. The principles are to stop the blood loss as soon as possible and to restore the lost volume to avoid the complications associated with traumatic hemorrhage. Surgical treatment in the acute situation is especially important due to its efficiency. The present article focuses on the current literature with respect to the appropriate diagnostic and treatment measures in the thoracic, abdominal and pelvic regions as well as the extremities and describes the latest scientific insights and developments. Available trauma algorithms are presented and the value of various strategies regarding surgical hemostasis for the thorax and abdomen are shown, whereby organ preservation can increasingly be achieved, particularly in the abdomen. With respect to hemostasis in severe pelvic injuries and injuries to the extremities, the regularly used surgical techniques are described and their values are differentially classified.

The situation of people with intellectual and developmental disabilities in the COVID-19 pandemic-risk factors, problem areas, and measures

Many people with intellectual and developmental disabilities (IDD) were much more affected by COVID-19 than the average population. The morbidity in this population group was significantly higher due to the form of their housing and care as well as disability-associated health factors (such as Down's syndrome). This led, among other things, to ahigher incidence of inpatient settings, ahigher mortality rate among hospitalized patients, and ahigher case fatality rate among certain subgroups. Risk factors were co-diseases such as dysphagia, epilepsy, or mental disorders. In addition, there were health consequences from restrictive exposure prophylaxis measures at the beginning of the COVID-19 pandemic.This overview article describes the main developments in the care of people with IDD since the beginning of the pandemic. New mental problems or an increase in existing mental problems occurred more frequently in people with IDD who were cared for on an outpatient basis or by relatives. People with IDD in inpatient residential facilities were less frequently affected. The main reasons for psychological problems were lack of social contacts, lost work and employment opportunities, the frightening pandemic situation, and the major structural and personnel changes in the facilities at the beginning of the pandemic. During the pandemic, there were also problems with the implementation of therapeutic and preventive measures. On the other hand, especially in the inpatient area, the "slowing down of life" associated with the restrictions at the beginning of the pandemic also had astress-reducing effect on some of the people with IDD and was perceived by them as something positive. Caregivers had more time for the genuine (i.e., pedagogical) work. Overall, it was shown that health-promoting measures must also take into account the great heterogeneity of the people with IDD and their living conditions during the pandemic.

Renal manifestations in connective tissue diseases

Connective tissue diseases (CTD) comprise agroup of inflammatory systemic diseases that can affect various organs. Kidney involvement is frequently associated with significant irreversible damage and often before patients become symptomatic. Screening tests of blood and urine as well as clinical vigilance are therefore essential for all CTDs with possible renal involvement. Akidney biopsy is the gold standard for the diagnosis, prognosis and treatment decisions. Acommon and severe organ involvement in systemic lupus erythematosus (SLE) is glomerulonephritis (GN), also collectively referred to as lupus nephritis (LN). If left untreated LN often leads to end-stage renal failure. The treatment depends on the clinical parameters and histopathology of the renal involvement. Mycophenolate mofetil and cyclophosphamide are potent but nonspecific immunosuppressants which have been available for many years. Recently, new substances specific for LN have also been approved for the first time. Kidney involvement in Sjogren's syndrome has been far less studied. In studies the frequency of renal involvement is still unclear and ranges from 5% to 33%. Tubulointerstitial nephritis (IN) is the typical form of renal involvement which clearly differs from GN in its clinical presentation. Recommendations for treatment are based exclusively on retrospective studies. Arenal crisis in systemic scleroderma (SSc) is a rare but feared complication with ahigh mortality. An antiphospholipid syndrome (APS) nephropathy (APSN) can occur during CTD. These entities are vasculopathies and often thrombotic microangiopathies, which clearly differ from GN and IN in terms of pathophysiology, clinical features and treatment. This article provides an overview of the diversity of the most important renal manifestations of CTDs.

Management of acutely decompensated liver cirrhosis in emergency and critical care medicine

Acute decompensation in patients with liver cirrhosis is characterized by the development of ascites, gastrointestinal bleeding, hepatic encephalopathy, or bacterial infection and is often accompanied by further extrahepatic organ dysfunction. Since critically ill patients with decompensated cirrhosis have ahigh mortality risk, rapid identification and treatment of the triggering event of decompensation (e.g., infection, hemorrhage, drugs) as well as specific measures for the treatment of concomitant extrahepatic organ dysfunctions are essential in order to improve the patient's prognosis and to prevent the development of acute-on-chronic liver failure (ACLF).

Surgical treatment of chest wall tumors

The term chest wall tumor summarizes aheterogeneous group of malignant and benign tumors, whereby primary and secondary chest wall tumors are differentiated. The incidence of secondary chest wall tumors is higher than that of primary tumors. Primary chest wall tumors can arise from any anatomic structure of the chest wall. Surgical resection is usually the treatment of choice. Resection status and tumor differentiation are relevant prognostic factors. Treatment of secondary chest wall tumors is performed depending on the patient's symptoms and prognosis of the underlying disease. Lung carcinomas infiltrating the chest wall can be resected primarily or secondarily as part of multimodal therapeutic strategies. Anatomic lung resections combined with chest wall resection have ahigher mortality than standard resections. Chest wall reconstruction after resection has the goal of reducing paradoxical respiratory motion, although not every chest wall defect requires reconstruction.

Management of acutely decompensated liver cirrhosis in emergency and critical care medicine

Acute decompensation in patients with liver cirrhosis is characterized by the development of ascites, gastrointestinal bleeding, hepatic encephalopathy, or bacterial infection and is often accompanied by further extrahepatic organ dysfunction. Since critically ill patients with decompensated cirrhosis have ahigh mortality risk, rapid identification and treatment of the triggering event of decompensation (e.g., infection, hemorrhage, drugs) as well as specific measures for the treatment of concomitant extrahepatic organ dysfunctions are essential in order to improve the patient's prognosis and to prevent the development of acute-on-chronic liver failure (ACLF).

Learning of flexible endoscopy, particularly endoscopic vacuum therapy (EVT).

Anastomotic insufficiency and perforations in the gastrointestinal tract are severe complications associated with ahigh complication rate and mortality. Conventional treatment options (particularly re-operations) are often unsatisfactory. Endoscopic vacuum therapy (EVT) is increasingly being used as apromising alternative. The use of EVT requires ahigh level of competence in interventional flexible endoscopy, which is primarily not available to every surgeon. Special training programs are required here. Based on this need the long-proven Tuebingen training system for flexible endoscopy was modified to meet the special requirements of surgeons and is currently being extended by aspecial training module for EVT. In addition to the theoretical principles, the training is focused on learning the manual skills for flexible endoscopy. A2-stage process was developed for this purpose: 1)to become familiar with handling of the flexible endoscope and to learn spatial orientation by means of adidactically optimized abstract phantom ("Tuebingen Orientophant") and 2)learning and training of EVT using anewly developed patient-analogous training model with various insufficiencies and abscess cavities in the upper and lower gastrointestinal tract ("Tuebinger Spongiophant"). The procedure can be trained hands-on step by step exactly as with the patient, whereby the sponge can be applied using different methods, such as overtube and dragging procedures. The consequences of mistakes and complication management can also ideally be trained hands-on using the phantom. Evaluations of the first course series show that surgeons achieve endoscopic competence very quickly and learn to master the new procedure. The structure of such acourse must, however, be designed according to long-term experience in an optimal didactic manner. Decision-makers in healthcare policy should give much more support to such courses in order to improve patient care and to increase patient safety.

Mortality in sepsis and septic shock in Germany. Results of asystematic review and meta-analysis

HintergrundVerschiedene Autoren diskutieren, ob fehlende Qualitätsinitiativen und Behandlungsstandards in Deutschland im internationalen Vergleich zu höherer Sterblichkeit bei Sepsis und septischem Schock führen könnten. Dem gegenüber steht eine international anerkannte intensivmedizinische Versorgung in Deutschland, z. B. während der COVID-19-Pandemie.Ziel der ArbeitZiel dieser Studie war es, die Sterblichkeit bei Sepsis und septischem Schock in Deutschland zu ermitteln und mit anderen Industrienationen zu vergleichen.Material und MethodenIn eine systematischen Literaturrecherche wurden alle zwischen 2009 und 2020 veröffentlichten Interventions- und Beobachtungsstudien aus den Datenbanken PubMed und Cochrane Library eingeschlossen. Die 30- und 90-Tages-Sterblichkeit bei Sepsis und septischem Schock wurde in einer Metaanalyse mittels „Random-effects“-Modells gepoolt.ErgebnisseInsgesamt wurden 134 Studien in die Meta-Analyse eingeschlossen. Die 30-Tages-Sterblichkeit bei Sepsis betrug in Deutschland 26,50 % (95 %-KI: 19,86–33,15 %), in Europa (ohne Deutschland) 23,85 % (95%-KI: 20,49–27,21 %) und in Nordamerika 19,58 % (95%-KI: 14,03–25,14 %). Die 30-Tages-Sterblichkeit bei septischem Schock betrug 30,48 % (95 %-KI: 29,30–31,67 %), 34,57 % (95 %-KI: 33,51–35,64 %) bzw. 33,69 % (95 %-KI: 31,51–35,86 %). Die 90-Tages-Sterblichkeit bei septischem Schock betrug 38,78 % (95 %-KI: 32,70–44,86 %), 41,90 % (95 %-KI: 38,88–44,91 %) beziehungsweise 34,41 % (95 %-KI: 25,66–43,16 %).DiskussionEs ergaben sich somit keine Anhaltspunkte dafür, dass die Sterblichkeit bei Sepsis/septischem Schock im internationalen Vergleich in Deutschland erhöht ist.Zusatzmaterial onlineDie Online-Version dieses Beitrags (10.1007/s00101-021-00917-8) enthält zusätzliche Informationen zu den eingeschlossenen Studien. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“.

Contemporary practice patterns in the treatment of Fournier's gangrene in German academic medicine and their implications for planning aregistry study

HintergrundDie Fournier-Gangrän (FG) ist ein seltenes, aber lebensbedrohliches Krankheitsbild, dessen Prognose in den letzten Jahren nicht wesentlich verbessert werden konnte.Ziel der ArbeitPrimäres Studienziel ist die Deskription der Therapiesituation von FG an deutschen Universitätskliniken. Als sekundäres Studienziel sollen Faktoren identifiziert werden, die mit einer erhöhten Letalität assoziiert sind. Außerdem sollen die Daten zur Planung einer Registerstudie dienen.Material und MethodenEs wurde ein Fragebogen mit 29 Fragen an die Mitglieder des Verbands Universitätsklinika Deutschlands sowie eine 3‑malige Erinnerung zur Studienteilnahme im Zeitraum April bis Juni 2020 versandt. Die Datenverwaltung und statistische Analyse erfolgte mit SPSS 26.0 (SPSS Inc., Chicago, Il, USA).ErgebnisseDie Antwortrate betrug 88,9 %. Im Median werden jährlich 5 Patienten mit einem medianen Alter von 60 Jahren an deutschen Universitätsklinika mit der Diagnose FG therapiert. Insgesamt stellt sich die Therapiesituation sehr heterogen dar, insbesondere hinsichtlich der empirischen Erstantibiose. Ein signifikanter Risikofaktor für eine Letalität > 20 % konnte identifiziert werden: Intensivaufenthalt von größer gleich 10 Tagen (p = 0,039). Die Hälfte (50,0 %) der Befragten geben an, dass sich die Prognose der Erkrankung nicht wesentlich verbessert hat. Weiterhin halten viele der Befragten die Letalität für inakzeptabel hoch, daher befürworten 84,4 % eine Registerstudie. Aus den Kommentaren der Befragten konnten zahlreiche Vorschläge sowie Implikationen für die Planung einer solchen Studie abgeleitet werden, wie z. B. die histologische Sicherung der FG.SchlussfolgerungDie Therapiesituation der FG ist heterogen. Allerdings sind die Therapieergebnisse weiterhin inakzeptabel und schwer prognostizierbar.

Treatment of COVID-19 Patients at Intensive Care Unit of General Hospital of Prizren

Introduction: Due to the COVID-19 pandemic, hospitals and especially the intensive care unit are and can be overloaded by the hypoxemic patients, and face many challenges. Methods: There was used retrospective observational study in a Kosovo hospital, the review of characteristics, clinical course and outcomes of all consecutive patients who had respiratory failure. In addition to data collected in ICU of patients with worsening symptoms and COVID-19 confirmed, similar publications in medical journals with keywords, coronavirus, SARS-CoV2, intensive care and treatment have also been reviewed. Results: During July, August and September, 797 confirmed patients with COVID-19 were admitted to the hospital, of which ninety-four patients (11.79%) were treated in the Central ICU of Prizren General Hospital. 59.58% were male, the youngest age was 34 years old, the oldest 84 and the average was 65.53 years old. Regarding the days of stay there were 0 up to 21 days of stay, the average was 5.06 days of stay. Out of 94 patients admitted 13 (13.83%) were discharged in improved condition at home, 19 (20.21%) were transferred out of ICU and 62 (65.96%) have died. The youngest of the dead was 46 years. while the oldest was 84 y, the average age of the dead was 68.06 years old. Conclusion: It is needed to adapt management and safe treatment protocols as well as the demand for multidisciplinary treatment. Patients with COVID-19 who need to be transferred to the ICU are complex and have a high mortality rate.