Inpatient Mortality According to Level of Respiratory Support Received for Severe Acute Respiratory Syndrome Coronavirus 2 (Coronavirus Disease 2019) Infection: A Prospective Multicenter Study

Alberto Palazzuoli¹, Franco Ruberto², Gaetano M De Ferrari³, Giovanni Forleo⁴, Gioel G Secco⁵, Gaetano M Ruocco⁶, Fabrizio D'Ascenzo³, Francesco Mojoli⁷, Silvia Monticone⁸, Anita Paggi⁹, Marco Vicenzi¹⁰, Silvia Corcione¹¹, Anna G Palazzo¹¹, Maurizio Landolina¹², Erika Taravelli¹², Guido Tavazzi⁷, Francesco Blasi¹³, Massimo Mancone¹⁴, Lucia I Birtolo¹⁴, Francesco Alessandri², Fabio Infusino¹⁴, Francesco Pugliese², Francesco Fedele¹⁴, Francesco Giuseppe De Rosa¹¹, Michael Emmett¹⁵, Jeffrey M Schussler^{15

16}, Peter A McCullough^{15

16

17}, Kristen M Tecson¹⁷

Affiliations

¹ Cardiovascular Diseases Unit, Department of Medical Sciences, AOUS Le Scotte Hospital, University of Siena, Siena, Italy.
² Department of General and Specialist Surgery "Paride Stefanini," Sapienza University of Rome, Rome, Italy.
³ Cardiology, Department of Medical Science, University of Turin, Città della Salute e Della Scienza Le Molinette Hospital Torino, Torino, Italy.
⁴ Section Head Electrophysiology and Cardiac Pacing, Azienda Ospedaliera-Polo Universitario-"Luigi Sacco," Milano, Italy.
⁵ Interventional Cardiology and Cardiac Surgery Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
⁶ Cardiology Division, Regina Montis Regalis Hospital Mondovì, Cuneo, Italy.
⁷ Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
⁸ Division of Internal Medicine, Department of Medical Sciences, University of Turin, Turin, Italy.
⁹ Interventional Cardiology, Department of Internal Medicine, ASSST Nord Milano E Bassini Hospital Cisanello Balsamo, Milan, Italy.
¹⁰ Cardiovascular Disease Unit, Department of Internal Medicine, University of Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
¹¹ Infectious Disease, Department of Medical Sciences, University of Torino, AOU Città della salute e della Scienza, Torino, Italy.
¹² Cardiology Division, Ospedale Maggiore of Crema, Crema, Italy.
¹³ Respiratory Unit and Adult Cystic Fibrosis Center, Department of Internal Medicine, University of Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
¹⁴ Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Roma, Italy.
¹⁵ Baylor University Medical Center, Dallas, TX.
¹⁶ Baylor Heart and Vascular Hospital, Dallas, TX.
¹⁷ Baylor Heart and Vascular Institute, Dallas, TX.

PMID: 32984838
PMCID: PMC7505344
DOI: 10.1097/CCE.0000000000000220

Inpatient Mortality According to Level of Respiratory Support Received for Severe Acute Respiratory Syndrome Coronavirus 2 (Coronavirus Disease 2019) Infection: A Prospective Multicenter Study

Alberto Palazzuoli et al. Crit Care Explor. 2020.

. 2020 Sep 18;2(9):e0220.

doi: 10.1097/CCE.0000000000000220. eCollection 2020 Sep.

Authors

Affiliations

¹ Cardiovascular Diseases Unit, Department of Medical Sciences, AOUS Le Scotte Hospital, University of Siena, Siena, Italy.
² Department of General and Specialist Surgery "Paride Stefanini," Sapienza University of Rome, Rome, Italy.
³ Cardiology, Department of Medical Science, University of Turin, Città della Salute e Della Scienza Le Molinette Hospital Torino, Torino, Italy.
⁴ Section Head Electrophysiology and Cardiac Pacing, Azienda Ospedaliera-Polo Universitario-"Luigi Sacco," Milano, Italy.
⁵ Interventional Cardiology and Cardiac Surgery Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
⁶ Cardiology Division, Regina Montis Regalis Hospital Mondovì, Cuneo, Italy.
⁷ Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
⁸ Division of Internal Medicine, Department of Medical Sciences, University of Turin, Turin, Italy.
⁹ Interventional Cardiology, Department of Internal Medicine, ASSST Nord Milano E Bassini Hospital Cisanello Balsamo, Milan, Italy.
¹⁰ Cardiovascular Disease Unit, Department of Internal Medicine, University of Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
¹¹ Infectious Disease, Department of Medical Sciences, University of Torino, AOU Città della salute e della Scienza, Torino, Italy.
¹² Cardiology Division, Ospedale Maggiore of Crema, Crema, Italy.
¹³ Respiratory Unit and Adult Cystic Fibrosis Center, Department of Internal Medicine, University of Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
¹⁴ Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Roma, Italy.
¹⁵ Baylor University Medical Center, Dallas, TX.
¹⁶ Baylor Heart and Vascular Hospital, Dallas, TX.
¹⁷ Baylor Heart and Vascular Institute, Dallas, TX.

PMID: 32984838
PMCID: PMC7505344
DOI: 10.1097/CCE.0000000000000220

Abstract

Objectives: To describe patients according to the maximum degree of respiratory support received and report their inpatient mortality due to coronavirus disease 2019.

Design: Analysis of patients in the Coracle registry from February 22, 2020, to April 1, 2020.

Setting: Hospitals in the Piedmont, Lombardy, Tuscany, and Lazio regions of Italy.

Patients: Nine-hundred forty-eight patients hospitalized for coronavirus disease 2019.

Interventions: None.

Measurements and main results: Among 948 patients, 122 (12.87%) received invasive ventilation, 637 (67.19%) received supplemental oxygen only, and 189 (19.94%) received no respiratory support. The median (quartile 1-quartile 3) age was 65 years (54-76.59 yr), and there was evidence of differential respiratory treatment by decade of life (p = 0.0046); patients greater than 80 years old were generally not intubated. There were 606 men (63.9%) in this study, and they were more likely to receive respiratory support than women (p < 0.0001). The rate of in-hospital death for invasive ventilation recipients was 22.95%, 12.87% for supplemental oxygen recipients, and 7.41% for those who received neither (p = 0.0004). A sensitivity analysis of the 770 patients less than 80 years old revealed a lower, but similar mortality trend (18.02%, 8.10%, 5.23%; p = 0.0008) among the 14.42%, 65.71%, and 19.87% of patients treated with mechanical ventilation, supplemental oxygen only, or neither. Overall, invasive ventilation recipients who died were significantly older than those who survived (median age: 68.5 yr [60-81.36 yr] vs 62.5 yr [55.52-71 yr]; p = 0.0145).

Conclusions: Among patients hospitalized for coronavirus disease 2019, 13% received mechanical ventilation, which was associated with a mortality rate of 23%.

Keywords: coronavirus disease 2019; inpatient mortality; invasive ventilation; respiratory support; severe acute respiratory syndrome coronavirus 2; supplemental oxygen.

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Conflict of interest statement

Dr. Mojoli received funding from GE Healthcare (fee for lectures), Hamilton Medical (fee for lectures), and Seda Spa (fee for lecture) and disclosed a consultancy agreement between University of Pavia and Hamilton Medical. On behalf of the Coracle registry, for the purpose of this study, no ICU data were retrieved by Drs. Corcione or Palazzo. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

**Figure 1.**
Respiratory support received according to age group of patients in Coracle registry hospitalized in Italy for coronavirus disease 2019 (COVID-19) infection

**Figure 2.**
Inpatient survival rates according to age group and respiratory support received of patients in Coracle registry hospitalized in Italy for coronavirus disease 2019 (COVID-19) infection

See this image and copyright information in PMC

References

1. Ford P, Foale M. Converting gas-driven ventilators from oxygen to air. Anaesthesia. 2020; 75:821. - PubMed
1. El Majid B, El Hammoumi A, Motahhir S, et al. Preliminary design of an innovative, simple, and easy-to-build portable ventilator for COVID-19 patients. EuroMediterr J Environ Integr. 2020; 5:23. - PMC - PubMed
1. Herrmann J, Fonseca da Cruz A, Hawley ML, et al. Shared ventilation in the era of COVID-19: A theoretical consideration of the dangers and potential solutions. Respir Care. 2020; 65:932–945 - PubMed
1. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet Respir Med. 2020; 8:475–481 - PMC - PubMed
1. Auld SC, Caridi-Scheible M, Blum JM, et al. ICU and ventilator mortality among critically ill adults with coronavirus disease 2019. Crit Care Med. 2020; 48:e799–e804 - PMC - PubMed

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Inpatient Mortality According to Level of Respiratory Support Received for Severe Acute Respiratory Syndrome Coronavirus 2 (Coronavirus Disease 2019) Infection: A Prospective Multicenter Study

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Inpatient Mortality According to Level of Respiratory Support Received for Severe Acute Respiratory Syndrome Coronavirus 2 (Coronavirus Disease 2019) Infection: A Prospective Multicenter Study

Authors

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Abstract

Conflict of interest statement

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