Baseline characteristics and outcomes of COVID-19 patients admitted to a Respiratory Intensive Care Unit (RICU) in Southern Italy

Valentina Di Lecce; Giovanna Elisiana Carpagnano; Paola Pierucci; Vitaliano Nicola Quaranta; Federica Barratta; Annapaola Zito; Enrico Buonamico; Onofrio Resta

doi:10.4081/mrm.2020.704

Baseline characteristics and outcomes of COVID-19 patients admitted to a Respiratory Intensive Care Unit (RICU) in Southern Italy

Authors

Valentina Di Lecce Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari
Giovanna Elisiana Carpagnano Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari
Paola Pierucci Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari https://orcid.org/0000-0002-0201-0486
Vitaliano Nicola Quaranta Pneumology Department, “Di Venere” Hospital, Bari
Federica Barratta Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari
Annapaola Zito Cardiology Department, "SS Annunziata" Hospital, Taranto https://orcid.org/0000-0003-4819-9971
Enrico Buonamico Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari https://orcid.org/0000-0001-6348-1356
Onofrio Resta Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari

DOI: https://doi.org/10.4081/mrm.2020.704

Keywords:

COVID-19, Acute respiratory failure, Respiratory Intensive Care Unit, Non-invasive respiratory support

Abstract

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^th to May 31^st 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 PaO₂/FiO₂ ratio between 100 and 200 and 17% showed Pa0₂/FiO₂ ratio <100. Mean Pa0₂/FiO₂ 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% was 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.

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