Clinical Outcomes of Severe COVID-19 Patients Admitted to an Intermediate Respiratory Care Unit

Abstract

Introduction: Many severe COVID-19 patients require respiratory support and monitoring. An intermediate respiratory care unit (IMCU) may be a valuable element for optimizing patient care and limited health-care resources management. We aim to assess the clinical outcomes of severe COVID-19 patients admitted to an IMCU.Methods: Observational, retrospective study including patients admitted to the IMCU due to COVID-19 pneumonia during the months of March and April 2020. Patients were stratified based on their requirement of transfer to the intensive care unit (ICU) and on survival status at the end of follow-up. A multivariable Cox proportional hazards method was used to assess risk factors associated with mortality.Results: A total of 253 patients were included. Of them, 68% were male and median age was 65 years (IQR 18 years). Ninety-two patients (36.4%) required ICU transfer. Patients transferred to the ICU had a higher mortality rate (44.6 vs. 24.2%; p < 0.001). Multivariable proportional hazards model showed that age ≥65 years (HR 4.14; 95%CI 2.31–7.42; p < 0.001); chronic respiratory conditions (HR 2.34; 95%CI 1.38–3.99; p = 0.002) and chronic kidney disease (HR 2.96; 95%CI 1.61–5.43; p < 0.001) were independently associated with mortality. High-dose systemic corticosteroids followed by progressive dose tapering showed a lower risk of death (HR 0.15; 95%CI 0.06–0.40; p < 0.001).Conclusions: IMCU may be a useful tool for the multidisciplinary management of severe COVID-19 patients requiring respiratory support and non-invasive monitoring, therefore reducing ICU burden. Older age and chronic respiratory or renal conditions are associated with worse clinical outcomes, while treatment with systemic corticosteroids may have a protective effect on mortality.

Early Measurement of ROX Index in Intermediary Care Unit Is Associated with Mortality in Intubated COVID-19 Patients: A Retrospective Study

“…The univariate analysis revealed that surviving patients had a lower median age (68 (59-74) vs. 70.5 (67-76.5); p = 0.04), lower APACHE II score (19 (11-28) vs. 27.5 (22.5-30), p < 0.01), and higher median ROX H0-H8 score (6.49 (5.39-9.04) vs. 5.57 (4.86-6.97), p = 0.04) compared with the non-survivor group, as shown in Table 2 and Figure 2. There was not any difference in the median duration from hospitalization to ICU intubation (3 (2-7) vs. 4.5 (3)(4)(5)(6)(7)(8), p = 0.23) nor median IMCU length of stay (2.5 (1-4) vs. 2 (1-5), p = 0.84) between both groups, as shown in Table 2. The multivariate analysis showed the median ROX H0-H8 to be independently associated with ICU mortality as a protective factor, with an odds ratio (OR) (95% CI) = 0.77 (0.60-0.99), p < 0.05, and APACHE II (including age) as a risk factor OR (95% CI) = 1.09 (1.02-1.15), p < 0.05, as seen in Table 3.…”

“…The development or upscaling of multidisciplinary intermediate care units (IMCU) has been proposed to relieve ICU units by taking charge of less severe patients and those who may be restricted from mechanical ventilation due to severe concomitant conditions [4,5].…”

Outcomes of COVID-19 Patients Admitted to the Intermediate Respiratory Care Unit: Non-Invasive Respiratory Therapy in a Sequential Protocol

“…To achieve the best potential benefit of any NRT on HRF management, the patient should be allocated to a monitored setting, being cared for by personnel experienced in NRT. The IRCU is a suitable setting for this purpose where qualified respiratory staff can manage this situation with efficiency and less cost than the ICU [ 9 , 10 ]. Nevertheless, ensuring prompt endotracheal intubation is mandatory if the patient presents acute deterioration or no improvement after an NRT short trial.…”

The RICU during the COVID Pandemic

“…There are scarce data regarding mortality in subjects with severe COVID-19, particularly in the RICU. Mortality varies widely among published series, ranging from 8 to 30% 11,14 .…”

“…Recently, some studies reported positive results on non-invasive respiratory strategies (NIRS) in patients with COVID-19 in RICU [13][14][15] . During the pandemic, RICU increased exponentially with the aim of avoiding ICU congestion.…”