Intensive Care Admission Rate Due To COVID-2109, a<br />narrative Review<br />Mohammed Abdul Zahra Sasaa1<br />and Ali fadihl Al-emran2<br />Abstract:<br /><br />A number of research has been published in few months regarding to novel virus (COV-2019) that<br />infected a high numerous of people within different countries in short time, no antivirus drug has<br />been confirmed to be active against coronavirus. Patients contaminated with 2019-nCoV are in<br />danger for creating respiratory failure and expecting admission to intensive care units. The danger of<br />respiratory failure requiring ICU support in patients infected with 2019-nCoV is considerable, thus<br />intensivists and anesthesiologists must be ready for newcomer and sustained care of patients infected<br />with 2019-nCoV.<br />Method:<br />We performed a narrative review via searching in three databases Pubmed, Google Scholar and<br />Embase for all studies that mentioned all intensive care admission rates for who infected with<br />coronavirus 2019, manual searching also completed. All the selected reviews were limited to the<br />English language and date also.<br />Result:<br />5 researches referred to rate of ICU admission, male cases was more compare to female, median age<br />range were (40-56) years, co-existing disease associated cases range from 23.7%-51%, ICU<br />admission rate range from 5%-32% and median rate was 19.84%, a massive number of patients<br />received oxygen therapy between (41.3%-76.81%, an intermediate number of cases was under noninvasive ventilation range from (4.9%-24%) and low number of patients received invasive<br />ventilation range from 3.3%-12.32%.<br />Conclusion:<br />The contamination of 2019-nCoV was more likely in old male with underling condition such as<br />hypertension, diabetes and others, this can made lethal respiratory symptoms, may develop<br />respiratory failure. So a big number of patients might be take place in ICUs.<br />Keywords: Coronavirus-2019, COVID-2019, admission, intensive care, and ICU<br />1) Assistant teacher at Al- mustaqbal collage university, department of anesthesia and intensive care unit, MSc in<br />anesthesia and intensive care technology, TUMS. AL- Sadar teaching hospital, Najaf,Iraq. Corresponding author,<br />Mohammed Abdul Zahra Sasaa, email address: [email protected]. phone number: +9647718991533.<br />2) Assistant teacher at Al- mustaqbal collage university, department of anesthesia and intensive care unit, MSc in<br />anesthesia and intensive care technology, TUMS. AL- Hussein teaching hospital, Karbala, Iraq. <br />Background:<br />A new version of virus has been spread in the<br />seafood market in city of Wuhan in China is<br />called coronavirus that give rise coronavirus<br />disease 2019 (COVID-19), (1-6). Last couples<br />of months, this unprecedented generation of<br />virus is transmitted from infected area to noninfected area in thirty days and attack many<br />group of peoples with different age and<br />sex,(7).This kind of virus is infected<br />respiratory system from mild such as sore<br />throat, headache, dry cough, fever and others<br />to severe symptoms like dyspnea, increase<br />respiratory frequency, decrease blood oxygen<br />saturation and may develop acute respiratory<br />distress syndrome (ARDS), this reported with<br />highly number of cases in old men associated<br />with comorbidities and might be extent to<br />shock and death.(8,9). Distinguished case<br />patient with COVID-19 were directly<br />segregated in designated wards in existing<br />hospitals, and they could be observe for<br />beginning of symptoms. Patients with this type<br />of virus need optimal monitoring and support<br />especially in late stage of infection, respiratory<br />support starting from only oxygen therapy to<br />invasive mechanical ventilation, also 13% of<br />coronavirus2019 patients are reported with<br />severe respiratory symptoms(10). And about<br />25% requiring ICU admission and 10% need<br />mechanical ventilation (8, 11, 12, 13, and 14).<br />The objective of this study was to determine<br />the intensive care admission rate of<br />coronavirus2019 patients.<br />Method:<br />This narrative review study was started after<br />searching the current literature available on<br />PUBMED, EMBASE and GOOGLE<br />SCHOLAR. Furthermore, citation reviews and<br />hand search of new journals related to<br />intensive care admission due to coronavirus<br />infected disease were done. We searched the<br />published studies from December 2019 till<br />March 2020 using keywords: coronavirus<br />2109, intensive care unit, admission and their<br />synonyms and acronyms. The study included<br />20 researches which are 5 articles mentioned<br />the exact number of cases admitted to<br />intensive care units, other articles are review<br />articles. The exclusion criteria were all studies<br />in other languages except English, letters to<br />editors, expert reviews, comments, opinions,<br />correspondences, spotlight, research<br />highlights, pediatric age groups and case<br />report. The aim was to review studies about<br />intensive care admission rates for all old age<br />groups and gender who suffer from respiratory<br />infection with novel virus called coronavirus<br />2019, inclusion criteria were all studies that<br />mentioned the number of patient with<br />COVID-19 need ICU admission.<br />Result and discussion:<br />After obtained twenty researches from three<br />databases of recent novel coronavirus2019 and<br />read it completely (5) articles showed that the<br />accurate numbers of ICU admission due to<br />COV-n2019 infected disease, other articles are<br />review and case report. (table1) referred to 5<br />researches with number of patients, intensive<br />care admission rates, mean ages, gender and<br />coexisting diseases, other review and case<br />report researches are only supported<br />documents and references.<br />On table1, Chen et al (15), referred that the<br />number of patient were (99), 67male, 32<br />female and median ages was 55.5years. 51%<br />of them had chronic medical illness;<br />admission to intensive care unit was 23%,<br />76% received oxygen therapy either by<br />performance face mask or nasal cannula, 13%<br />received non-invasive mechanical ventilation <br />and 4% under invasive mechanical ventilation.<br />Two patients die after (9-11) days of<br />admission to ICU and both of them were over<br />60 years old and also they developed severe<br />ARDS and respiratory failure, this outcome<br />propose that the rate of ICU admission was<br />more probably in older male patients with coexisting disease with or without smoking in<br />COVID patients due to Weakened immune<br />system (16,17,18,19). Guan (20) and his<br />group mentioned that (1099) patients, median<br />ages of them was 47years, 640 males and 459<br />females. 23.7% had co-morbidities; only 5%<br />of them admitted to intensive care unit for<br />respiratory support, 41.3% received O2<br />therapy, 5.1% on non-invasive mechanical<br />ventilation and just 2.3% under invasive<br />mechanical ventilation. Admission to ICU was<br />(19.1%) in those with higher severity of<br />disease who median ages of them were<br />55years and most of them were smoker<br />(77.9%) and male 100 in number.<br />Wang et al (21) write about (138) patients,<br />median ages of them was 56 years, 75 males<br />and 63 females, 46.4% suffered from morbid<br />disease and 26.1 admitted to ICU due to organ<br />malfunction. Patients who required ICU care<br />were significantly older (median age, 66<br />years) and were more likely to have<br />underlying comorbidities, including<br />hypertension, diabetes, cardiovascular disease<br />and cerebrovascular disease. 76.81% received<br />oxygen therapy, 10.9% non-invasive<br />ventilation and 12.32% with invasive<br />mechanical ventilation. The rate of die patients<br />who admitted to ICU was high about 16.7%<br />and approximately half of them were under<br />mechanical ventilation. The most common<br />complication of COVID-19 ICU patients were<br />shock ARDS, arrhythmia and acute cardiac<br />injury. Liu et al (22), described that (61)<br />patients with coronavirus disease, median ages<br />of them 40 years, and 31 of them were males,<br />30 were males. 37.7% of them with coexisting disease and 13.1% were admitted to<br />intensive care unit, 57.4% treated with oxygen<br />therapy, 4.9% received non- invasive<br />ventilation and 3.3% were under control<br />invasive ventilation. Patients with age ≥ 50 are<br />most likely to transfer to intensive care unit<br />for supporting ventilation (22, 23).<br />Huang et al (24), noted that (41) patients<br />confirmed with COV-19, median ages of them<br />49 years. Most of them were males 30<br />compare with females 11, 32% with comorbidities and 32% were admitted to<br />intensive care unit, because they developed<br />hypoxemia. In this paper the death rate after<br />admitted to ICU was very high (38%) and it<br />was associated with 85% of men and 38% of<br />these patients had co-existing disease. This<br />study demonstrated that 2019-nCoV infection<br />is more effective in old age male patients with<br />co-morbidities with a little higher in smoker<br />group, 4 articles mentioned that the median<br />time from onset of symptoms to ICU<br />admission was 8-10.5 days. A massive number<br />of infected patients admitted to the ICU, by<br />simple mathematical calculation (arithmetic<br />mean), we can sum all outcome of ICU<br />admission (23+5+26.1+32+13.1) divide by<br />number of articles that mentioned rate of ICU<br />admission and it is 5. We can get rate<br />(19.84%) this number refer to ICU admission<br />rate due to coronavirus infected disease, and<br />it's close to rate (18%) that mentioned in Ming<br />et al research(25).<br />Conclusion:<br />A greater number of 19-COVID cases<br />admitted to intensive care unit, most of cases<br />are old age male with different co-existing<br />disease, a large number of ICU admission<br />patients has been died. ICUs are created in<br />order to look for patients that need ventilators,<br />blood pressure support and medication, cutting <br />edge treatments and close monitoring by<br />doctors and other health care staff,<br />unfortunately the care is different with<br />WAHAN virus, this lay all facilities and team<br />under tension and trouble situation.<br />Consequently a many papers and guidelines<br />has been published in few months to<br />recommend all of anesthesiologist,<br />intensivists and other intensive health care<br />provider due to this extremely number of 19-<br />COVIED patients that admitted to ICU or may<br />be in emergency department.<br />These papers are described more details<br />related airway assessment, airway<br />management, difficult airway, equipment<br />preparation, experienced anesthesiologist, and<br />the serious matter is Infection control<br />precautions.<br />Limitation:<br />There were some limitations in the study.<br />First, Lack of studies that referred to number<br />of ICU admission due to 2019-COVID<br />because short period of time, second, there is<br />shortage of information on length of stay in<br />ICU that will support our review article and<br />human error searching might be one of the<br />most cause of missing articles.<br />References:<br />1. 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