Outcomes of Covid-19 Patients Admitted to the Intermediate Respiratory Care Unit: Non-invasive Respiratory Therapy in a Sequencial Protocol

Abstract

Recognizing patients that best benefited from non-invasive respiratory therapies (NRTs) in intermediate respiratory care units (IRCU) is crucial to ensure management and limiting resources during COVID pandemic. To assess factors associated with survival, intensive care unit (ICU) admission and intubation likelihood in COVID-19 patients admitted to IRCU.Methods Observational retrospective study in consecutive patients admitted to IRCU of a tertiary hospital from March-2020 to April-2021. Inclusion criteria: Hypoxemic respiratory failure (Sp02 <=94% and/or respiratory rate >=25rpm with Fi02 >50% supplementary oxygen) due to acute COVID-19 infection. Demographic, comorbidities, clinical and analytical data, medical and NRTs were collected at IRCU admission. Multivariate logistic regression models assessed factors associated with survival, ICU admission and intubation. Results From 679 patients, 79 patients (12%) had order to do not intubation. From de remaining 600 (88%), 81% survived, 41% needed ICU admission and 37% required intubation. During IRCU, 51% required non-invasive ventilation (NIV group) and 49% did not (non-NIV group). Longer age and lack of corticosteroid treatment were associated with higher mortality and intubation risk in the entire cohort and among NIV group; among non-NIV group, lack of corticosteroids (any regimen) was associated with higher mortality; Admission during the first wave, and higher serum lactate dehydrogenase (LDH) and C-reactive protein (CRP) were associated with higher intubation risk. Conclusions 57% improved at IRCU with no ICU admission. The use of corticosteroids improved outcomes. A bolus plus progressive tapering scheme could be more beneficial in severe forms. Initial NIV does not always mean worse outcomes.