Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy.
Department of Medicine and Surgery Univeristy of Parma.
Acta Biomed. 2021 Nov 3;92(5):e2021365. doi: 10.23750/abm.v92i5.11417.
During the first wave of the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) pandemic, we faced a massive clinical and organizational challenge having to manage critically ill patients outside the Intensive Care Unit (ICU). This was due to the significant imbalance between ICU bed availability and the number of patients presenting Acute Hypoxemic Respiratory Failure caused by SARS-CoV-2-related interstitial pneumonia. We therefore needed to perform Non-Invasive Ventilation (NIV) in non-intensive wards to assist these patients and relieve pressure on the ICUs and subsequently implemented a new organizational and clinical model. This study was aimed at evaluating its effectiveness and feasibility.
We recorded the anamnestic, clinical and biochemical data of patients undergoing non-invasive mechanical ventilation while hospitalized in non-intensive CoronaVirus Disease 19 (COVID-19) wards. Data were registered on admission, during anesthesiologist counseling, and when NIV was started and suspended. We retrospectively registered the available results from routine arterial blood gas and laboratory analyses for each time point.
We retrospectively enrolled 231 patients. Based on our criteria, we identified 46 patients as NIV responders, representing 19.9% of the general study population and 29.3% of the patients that spent their entire hospital stay in non-ICU wards. Overall mortality was 56.2%, with no significant differences between patients in non-intensive wards (57.3%) and those later admitted to the ICU (54%) Conclusions: NIV is safe and manageable in an emergency situation and could become part of an integrated clinical and organizational model.
在严重急性呼吸系统综合征冠状病毒 2 型（SARS-CoV-2）大流行的第一波期间，我们面临着巨大的临床和组织挑战，需要在重症监护病房（ICU）之外管理重症患者。这是由于 ICU 床位可用性与因 SARS-CoV-2 相关间质性肺炎而导致急性低氧性呼吸衰竭的患者数量之间存在显著失衡。因此，我们需要在非重症病房进行无创通气（NIV）以帮助这些患者，并减轻 ICU 的压力，随后实施了新的组织和临床模式。本研究旨在评估其有效性和可行性。
我们记录了在非重症 COVID-19 病房住院期间接受无创机械通气的患者的病史、临床和生化数据。数据在入院时、麻醉师咨询时以及开始和暂停 NIV 时进行登记。我们回顾性登记了每个时间点常规动脉血气和实验室分析的可用结果。
我们回顾性纳入了 231 名患者。根据我们的标准，我们确定了 46 名 NIV 应答者，占总研究人群的 19.9%，占在非 ICU 病房住院的患者的 29.3%。总体死亡率为 56.2%，非重症病房的患者（57.3%）与后来转入 ICU 的患者（54%）之间无显著差异。结论：在紧急情况下，NIV 是安全且易于管理的，可以成为综合临床和组织模式的一部分。
