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Observational Study
. 2023 Jan;68(1):67-76.
doi: 10.4187/respcare.10193. Epub 2022 Nov 8.

Clinical Findings and Outcomes From Subjects With COVID-19 Pneumonia in an Intermediate Respiratory Care Unit

Daniel Laorden  1 , Soraya Gholamian-Ovejero  2 , José Rafael Terán-Tinedo  3 , Miguel Lorente-González  4 , Eduardo Cano-Sanz  5 , María Ángeles Ortega-Fraile  5 , Roberto-Martínez Alejos  6 , Joaquín Hernández-Nuñez  5 , Isabel De La Calle-Gil  7 , Rosalía Navarro-Casado  7 , Fernando Neria  8 , Annette Zevallos-Villegas  4 , Pablo Mariscal-Aguilar  1 , Miguel Suarez-Ortiz  1 , María Cristina Plaza-Moreno  1 , Daniel Carballo-López  9 , Berta Gallego-Rodríguez  7 , Mariara Calderón-Alcala  10 , Aylaf Latif-Essa  11 , María Churruca-Arróspide  12 , Manuel Valle-Falcones  12 , Elena María Saiz-Lou  13 , Carmen Rodríguez-Calle  14 , Clotilde Funes-Moreno  15 , Tomas Villén-Villegas  16 , Pedro Landete  17 ; UCRIZENDAL Study Group Investigators
Affiliations
Observational Study

Clinical Findings and Outcomes From Subjects With COVID-19 Pneumonia in an Intermediate Respiratory Care Unit

Daniel Laorden et al. Respir Care. 2023 Jan.

Abstract

Background: Many patients with COVID-19 require respiratory support and close monitoring. Intermediate respiratory care units (IRCU) may be valuable to optimally and adequately implement noninvasive respiratory support (NRS) to decrease clinical failure. We aimed at describing intubation and mortality in a novel facility entirely dedicated to COVID-19 and to establish their outcomes.

Methods: This was a retrospective, observational study performed at one hospital in Spain. We included consecutive subjects age > 18 y, admitted to IRCU with COVID-19 pneumonia, and requiring NRS between December 2020-September 2021. Data collected included mode and usage of NRS, laboratory findings, endotracheal intubation, and mortality at day 30. A multivariable Cox model was used to assess risk factors associated with clinical failure and mortality.

Results: A total of 1,306 subjects were included; 64.6% were male with mean age of 54.7 y. During the IRCU stay, 345 subjects clinically failed NRS (85.5% intubated; 14.5% died). Cox model showed a higher clinical failure in IRCU upon onset of symptoms and hospitalization was < 10 d (hazard ratio [HR] 1.59 [95% CI 1.24-2.03], P < .001) and PaO2 /FIO2 < 100 mm Hg (HR 1.59 [95% CI 1.27-1.98], P < .001). These variables were not associated with increased 30-d mortality.

Conclusions: The IRCU was a valuable option to manage subjects with COVID-19 requiring NRS, thus reducing ICU overload. Male sex, gas exchange, and blood chemistry at admission were associated with worse prognosis, whereas older age, gas exchange, and blood chemistry were associated with 30-d mortality. These findings may provide a basis for better understanding outcomes and to improve management of noninvasively ventilated patients with COVID-19.

Keywords: COVID-19; high-flow nasal cannula; intermediate care unit; mortality; noninvasive respiratory strategies; prognosis.

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Conflict of interest statement

Mr Martínez-Alejos is part-time employee at Philips France. The remaining authors have disclosed no conflicts of interests.

Figures

Fig. 1.
Fig. 1.
Algorithm to guide noninvasive respiratory strategies implementation in intermediate respiratory care unit. IRCU = intermediate respiratory care unit; HFNC = high-flow nasal cannula; ROX = ratio of oxygen saturation; WOB = work of breathing; NIV = noninvasive ventilation.
Fig. 2.
Fig. 2.
Flow chart. IRCU = intermediate respiratory care unit.
Fig. 3.
Fig. 3.
Cox proportional hazards method to assess risk factors associated with clinical failure and mortality. (A) Kaplan-Meier analysis of clinical failure probability in intermediate respiratory care unit (IRCU) depending on time of symptoms onset and IRCU admission; (B) Kaplan-Meier analysis of 30-d survival probability in IRCU depending on time upon symptoms onset and IRCU admission; (C) Kaplan-Meier analysis of clinical failure probability in IRCU depending on PaO2/FIO2 at admission; (D) Kaplan-Meier analysis of 30-d survival probability in IRCU depending on PaO2/FIO2 at admission.
See this image and copyright information in PMC

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