Page 21 - Delaware Medical Journal - July/August 2020

CASE STUDY
Figure 2
Comorbidities
Most frequent comorbidities were hypertension (54%), obesity (52%), diabetes mellitus (25%), and lung disease (17%). The comorbidities associated with the greatest mortality were obesity, hypertension, and diabetes mellitus (see Figure 3).
Hospital Course
Upon admission, nine patients were placed on mechanical ventilation in the ICU, 12 went to ICU without requiring mechanical ventilation, and the other 79 were admitted to Med/Surg.
During their hospitalization, 20% of patients required the use of a ventilator. The average length of stay (LOS) on a ventilator was 10.0 days. These patients spent, on average, a total of 13.4 days in the ICU and had a total hospitalization LOS of 19.2 days. Forty
percent of patients were admitted to the ICU during their stay. Half of these patients were on a ventilator and are discussed above. The other 20 patients spent 3.5 days in the ICU and, on average, had a total hospitalization time of 11.5 days. Sixty patients were admitted to Med/Surg only. For these patients, the average LOS was 9.2 days. One patient was admitted to Med/ Surg for 20 days, transferred to another hospital for a procedure where he remained on a general Med/Surg Unit for four days and was then transferred back to Beebe Healthcare for seven days on Med/Surg before being discharged. This patient's journey is shown with an empty space for four days, in Figure 1.
The mortality rate among the 20 patients who were ventilated was 35%. The mortality rate for the 20 patients who had an ICU stay but were not ventilated was 25%. The mortality rate among Med/Surg patients was 10%.
Forty-seven percent of patients stayed 1-7 days, 25% stayed 8-14 days, 15% stayed 15- 21 days, 7% stayed 22-28 days, and 6% were admitted for longer than 28 days.
Treatment
Most of our initial patients were treated with hydroxychloroquine and azithromycin as per the recommendations at that time.13, 14 Many received corticosteroids, including methylprednisolone, prednisone, and dexamethasone.15, 16, 17 Given the small number of patients in this initial series, data regarding treatment is not statistically meaningful. However, overall consensus
was that corticosteroids, vapotherm, proning, and convalescent plasma were felt to be effective treatments, whereas hydroxychloroquine and azithromycin were not.18, 19 Patients suspected to have cytokine release syndrome, as suggested
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