Di Lecce Valentina, Carpagnano Giovanna Elisiana, Pierucci Paola, Quaranta Vitaliano Nicola, Barratta Federica, Zito Annapaola, Buonamico Enrico, Resta Onofrio
Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari.
Pneumology Department, "Di Venere" Hospital Bari.
Multidiscip Respir Med. 2020 Nov 6;15(1):704. doi: 10.4081/mrm.2020.704. eCollection 2020 Jan 28.
The recent Coronavirus disease 19 (COVID-19) pandemic, first in China and then also in Italy, brought to the attention the problem of the saturation of Intensive Care Units (ICUs). Almost all previous reports showed that in ICU less than half of patients were treated with invasive mechanical ventilation (IMV) and the rest of them with non-invasive respiratory support. This highlighted the role of respiratory intensive care units (RICUs), where patients with moderate to severe respiratory failure can be treated with non-invasive respiratory support, avoiding ICU admission. In this report, we describe baseline characteristics and clinical outcomes of 97 patients with moderate to severe respiratory failure due to COVID-19 admitted to the RICU of the Policlinico of Bari from March 11 to May 31 2020. In our population, most of the subjects were male (72%), non-smokers (76%), with a mean age of 69.65±14 years. Ninety-one percent of patients presented at least one comorbidity and 60% had more than two comorbidities. At admission, 40% of patients showed PaO/FiO ratio between 100 and 200 and 17% showed Pa0/FiO ratio <100. Mean Pa0/FiO ratio at admission was 186.4±80. These patients were treated with non-invasive respiratory support 40% with CPAP, 38% with BPAP, 3% with HFNC, 11% with standard oxygen therapy or with IMV through tracheostomy (patients in step down from ICU, 8%). Patients discharged to general ward (GW) were 51%, 30% were transferred to ICU and 19% died. To the best of our knowledge, this is one of the few described experiences of patients with respiratory failure due to COVID-19 treated outside the ICU, in a RICU. Outcomes of our patients, characterized by several risk factors for disease progression, were satisfactory compared with other experiences regarding patients treated with non-invasive respiratory support in ICU. The strategical allocation of our RICU, between ED and ICU, might have positively influenced clinical outcomes of our patients.
近期的新型冠状病毒肺炎（COVID-19）大流行，先是在中国，随后在意大利，引发了对重症监护病房（ICU）饱和问题的关注。几乎所有先前的报告都显示，在ICU中，接受有创机械通气（IMV）治疗的患者不到一半，其余患者接受无创呼吸支持治疗。这凸显了呼吸重症监护病房（RICU）的作用，在那里，中重度呼吸衰竭患者可以接受无创呼吸支持治疗，避免入住ICU。在本报告中，我们描述了2020年3月11日至5月31日入住巴里综合医院RICU的97例因COVID-19导致中重度呼吸衰竭患者的基线特征和临床结局。在我们的研究人群中，大多数受试者为男性（72%），非吸烟者（76%），平均年龄为69.65±14岁。91%的患者至少有一种合并症，60%的患者有两种以上合并症。入院时，40%的患者动脉血氧分压/吸入氧浓度（PaO/FiO）比值在100至200之间，17%的患者PaO/FiO比值<100。入院时平均PaO/FiO比值为186.4±80。这些患者接受无创呼吸支持治疗，40%采用持续气道正压通气（CPAP），38%采用双水平气道正压通气（BPAP），3%采用高流量鼻导管吸氧（HFNC），11%采用标准氧疗或通过气管切开进行IMV（从ICU转入的患者，8%）。出院至普通病房（GW）的患者为51%，30%转入ICU，19%死亡。据我们所知，这是少数关于在RICU而非ICU治疗的COVID-19呼吸衰竭患者的描述性经验之一。与其他关于在ICU接受无创呼吸支持治疗患者的经验相比，我们患者的结局令人满意，这些患者具有多种疾病进展的风险因素。我们的RICU在急诊科和ICU之间的战略分配可能对我们患者的临床结局产生了积极影响。
