This study reports the epidemiology of the first patients who were admitted to the ICU with confirmed infection by SARS-CoV-2 in Vitoria, Spain. Findings suggests that a strategy of right oxygenation avoiding non-invasive mechanical ventilation was life-saving. After 15 days of ICU admission, half of patients remained intubated, whereas one third died.

The authors examined data from all consecutive COVID-19 adult patients between March 4, 2020 and March 31, 2020. Patients were followed until ICU death or discharge. Mortality was assessed in those who completed 7-days of ICU stay.

They identified 48 patients with confirmed SARS-CoV-2. Characteristics of these patients included:

• Median [interquartile range (IQR)] age was 63 [51-75] years.
• 27 were male.
• Symptoms began a median of 7 [5-12] days before ICU admission.
• The most common comorbidities were obesity (n = 48%), arterial hypertension (n = 44%) and chronic lung disease (n = 37%).
• All patients were admitted by hypoxemic respiratory failure.
• None received non-invasive mechanical ventilation.
• Forty-five (94%) underwent intubation, 3 HFNT, 1 (2%) extracorporeal membrane oxygenation (ECMO) and 22 (49%) required prone position.
• After 15 days, 14/45 (31%) intubated patients died (13% within one week), 10 (22%) were extubated, and 21/45 (47%) underwent mechanical ventilation.
• 6 patients had documented co-infection.
• Procalcitonin plasma above 0.5 µg/L was associated with 16% vs. 19% (p = 0.78) risk of death after 7 days.
• Seven-day mortality in SARS-CoV-2 requiring intubation was lower than 15%, with 80% of patients still requiring mechanical ventilation.