Recently, Sichuan International Medical Exchange & Promotion Association has worked with people.cn, Xinhua News Agency, IFENG.COM, dxy.cn, sina.com.cn, qq.com and other first-tier media to conduct a special report on the Sichuan experience on COVID-19 treatment:

The effective treatment of critically ill patients with COVID-19 is the key to reducing the overall mortality. From January 16 to March 15, 2020, a total of 539 diagnosed patients were treated in Sichuan, 81 of which met the national criteria for medium severe and critically ill patient standard specified in COVID-19 Diagnosis and Treatment Plan. Its 28-day overall fatality rate is 0.6% (3/539), and the mortality rate of severe and critically ill patients is 3.7%, which are lower than the domestic average (overall mortality rate at 2.3%, and critically patient mortality rate at 8.1%) and average of other parts of the world (overall global mortality rate at about 6%).

Initiated by West China Hospital, Sichuan University, a total of 21 hospitals including Public Health Clinical Center of Chengdu, West China Guang'an Hospital, Sichuan University, Ganzi People's Hospital, etc., which participated in the treatment of critically ill patients of Novel Coronavirus Pneumonia, and the Clinical Research Center of the Shanghai First Maternity and Infant Hospital formed Study of 2019 Novel Coronavirus Pneumonia Infected Critically Ill Patients in Sichuan Province, SUNRISE and conducted a follow-up and analysis on the above 81 cases of severe and critically ill patients. The study shows that:

1. The median age of critically ill patients in this group is 50 (39-65) years old, 37% of which are female, and 53.1% of which have chronic comorbidities;

2. According to the national scheme for clinical classification of medium severe and critically ill standards and daily reporting system, all critically ill patients were identified before intubation, where the oxygenation index <300 mmHg is the most sensitive one of the five diagnostic indicators, and the sensitivity rate was 87.7%;

3. All critically ill patients are admitted to the intensive care department of the designated hospital or the "temporary ICU" established quickly to provide patients with necessary monitoring, supportive equipment and critical care management team to ensure that all critical patients could receive appropriate monitoring and treatment for critical ill patients. 95.1% (77) of patients were transferred to ICU or "temporary ICU" before or on the day of diagnosis of critically ill patients. During the overall treatment, 63% (51) of critically ill patients were treated in the "temporary ICU";

4. 76 patients (93.8%) received different types of respiratory support treatment on the day of diagnosis as critically ill patients, including 55 patients through traditional oxygen therapy (67.9%), eight patients through nasal high-flow oxygen inhalation (9.9%), and 13 patients through noninvasive ventilation (16.1%). No patient needed invasive mechanical ventilation or ECMO support on the day of diagnosis.

5. Throughout the treatment of critically ill patients, traditional oxygen therapy is the most common respiratory support (62.7%), followed by nasal high-flow oxygen inhalation (19.3%), noninvasive ventilation (9.4%), invasive ventilation (8.5%), and ECMO (0.06%).

This study shows that under the current lack of effective treatment drugs for COVID-19, Sichuan's treatment experience suggests that early identification and timely provision of reasonable respiratory support can keep the mortality rate of critically ill patients of COVID-19 at a low level. In the early stage of critically ill patients of COVID-19, close monitoring and traditional oxygen therapy should be the recommended treatment measures in priority.

The research has been published on the pre-printed platform of Medrix, with corresponding authors Professor Kang Yan and Professor Jin Xiaodong of the Department of Intensive Care, West China Hospital, Sichuan University.

（https://www.medrxiv.org/content/10.1101/2020.03.22.20041277v2.article-metrics）

Figure 1. Distribution and transport map of critically ill patients with COVID-19 in Sichuan Province

81 critically ill patients were distributed in 13 cities and two autonomous prefectures in Sichuan Province. The dark blue dots represent 18 designated hospitals that treated critically ill patients with COVID-19, the pink dots represent 30 designated hospitals that treated non-critically ill patients with COVID-19, and the green dots represent non-designated hospitals. The red and green arrows represent transfer and outpatient visits respectively. The figure shows the process of centralized management of critically ill patients.

Figure 2. Daily vital organ function support of 81 patients from the day of diagnosis as critically ill patients (D1) to the 28th day (D28).

This figure shows the daily respiratory support and renal replacement therapy for critically ill patients of COVID-19 from D1 to D28.

Figure 3. Respiratory support in critically ill patients with COVID-19 during the study (January 16 to March 15).

The histogram represents the daily amount of respiratory support. The black, purple, and blue lines represent the number of new cases per day, the number of new critically ill cases per day, and the cumulative number of hospitalized critically ill cases in Sichuan Province.