Feasibility and clinical impact of out-of-ICU noninvasive respiratory support in patients with COVID-19-related pneumonia
Professor: Charlotte Ulrik
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Introduction: The severe acute respiratory syndrome-coronavirus 2 outbreak spread rapidly in Italy andIntroduction: The severe acute respiratory syndrome-coronavirus 2 outbreak spread rapidly in Italy andthe lack of intensive care unit (ICU) beds soon became evident, forcing the application of noninvasiverespiratory support (NRS) outside the ICU, raising concerns over staff contamination. We aimed toanalyse the safety of the hospital staff and the feasibility and outcomes of NRS applied to patients outsidethe ICU.
Methods: In this observational study, data from 670 consecutive patients with confirmed coronavirusMethods: In this observational study, data from 670 consecutive patients with confirmed coronavirusdisease 2019 referred to pulmonology units in nine hospitals between March 1 and May 10, 2020 wereanalysed. Data collected included medication, mode and usage of NRS (i.e. high-flow nasal cannula(HFNC), continuous positive airway pressure (CPAP), noninvasive ventilation (NIV)), length of stay inhospital, endotracheal intubation (ETI) and deaths.
Results: 42 (11.1%) healthcare workers tested positive for infection, but only three of them requiredResults: 42 (11.1%) healthcare workers tested positive for infection, but only three of them requiredhospitalisation. Data are reported for all patients (69.3% male), whose mean±SD age was 68±13 years. Thearterial oxygen tension/inspiratory oxygen fraction ratio at baseline was 152±79, and the majority (49.3%)of patients were treated with CPAP. The overall unadjusted 30-day mortality rate was 26.9%, with 16%,30% and 30% for HFNC, CPAP and NIV, respectively, while the total ETI rate was 27%, with 29%, 25%and 28%, respectively; the relative probability of death was not related to the NRS used after adjustmentfor confounders. ETI and length of stay were not different among the groups. Mortality rate increased withage and comorbidity class progression.
Conclusions: The application of NRS outside the ICU is feasible and associated with favourable outcomes.Conclusions: The application of NRS outside the ICU is feasible and associated with favourable outcomes.Nonetheless, it was associated with a risk of staff contamination.