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. 2023 Feb 16;12(4):1562.
doi: 10.3390/jcm12041562.

Clinical Characteristics and Outcomes of Patients with Acute Respiratory Failure Due to SARS-CoV-2 Interstitial Pneumonia Treated with CPAP in a Medical Intermediate Care Setting: A Retrospective Observational Study on Comparison of Four Waves

Silvia Accordino  1 , Ciro Canetta  1 , Greta Bettini  1 , Federica Corsico  1 , Gabriele Ghigliazza  1 , Laura Barbetta  1 , Christian Folli  1 , Valeria Savojardo  1 , Francesco Blasi  2   3
Affiliations

Clinical Characteristics and Outcomes of Patients with Acute Respiratory Failure Due to SARS-CoV-2 Interstitial Pneumonia Treated with CPAP in a Medical Intermediate Care Setting: A Retrospective Observational Study on Comparison of Four Waves

Silvia Accordino et al. J Clin Med. .

Abstract

Background: In COVID-19 patients non-invasive-positive-pressure-ventilation (NIPPV) has held a challenging role to reduce mortality and the need for invasive mechanical ventilation (IMV). The aim of this study was to compare the characteristics of patients admitted to a Medical Intermediate Care Unit for acute respiratory failure due to SARS-CoV-2 pneumonia throughout four pandemic waves.

Methods: The clinical data of 300 COVID-19 patients treated with continuous positive airway pressure (CPAP) were retrospectively analysed, from March-2020 to April-2022.

Results: Non-survivors were older and more comorbid, whereas patients transferred to ICU were younger and had fewer pathologies. Patients were older (from 65 (29-91) years in I wave to 77 (32-94) in IV, p < 0.001) and with more comorbidities (from Charlson's Comorbidity Index = 3 (0-12) in I to 6 (1-12) in IV, p < 0.001). No statistical difference was found for in-hospital mortality (33.0%, 35.8%, 29.6% and 45.9% in I, II, III and IV, p = 0.216), although ICU-transfers rate decreased from 22.0% to 1.4%.

Conclusions: COVID-19 patients have become progressively older and with more comorbidities even in critical care area; from risk class analyses by age and comorbidity burden, in-hospital mortality rates remain high and are thus consistent over four waves while ICU-transfers have significantly reduced. Epidemiological changes need to be considered to improve the appropriateness of care.

Keywords: COVID-19 waves; Intermediate Care Unit; acute respiratory failure; comorbidities; continuous positive airway pressure; in-hospital mortality.

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Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Living Guidance for Clinical Management of COVID-19: Living Guidance, 23 November 2021 World Health Organization (WHO) [(accessed on 8 February 2023)]; Available online: https://www.who.int/
    1. Sullivan Z.P., Zazzeron L., Berra L., Hess D.R., Bittner E.A., Chang M.G. Noninvasive respiratory support for COVID-19 patients: When, for whom and how? J. Intensiv. Care. 2022;10:1–10. doi: 10.1186/s40560-021-00593-1. - DOI - PMC - PubMed
    1. Perkins G.D., Ji C., Connolly B.A., Couper K., Lall R., Baillie J.K., Bradley J.M., Dark P., Dave C., De Soyza A., et al. Effect of noninvasive respiratory strategies on Intubation or mortality among patients with acute hypoxemic respiratory failure and COVID-19. The RECOVERY-RS Randomized Clinical Trials. JAMA. 2022;327:546. doi: 10.1001/jama.2022.0028. - DOI - PMC - PubMed
    1. Franco C., Facciolongo N., Tonelli R., Dongilli R., Vianello A., Pisani L., Scala R., Malerba M., Carlucci A., Negri E.A., et al. Feasibility and clinical impact of out-of-ICU non-invasive respiratory support in patients with COVID-19 related pneumonia. Eur. Respir. J. 2020;56:2002130. doi: 10.1183/13993003.02130-2020. - DOI - PMC - PubMed
    1. Grieco D.L., Menga L.S., Cesarano M., Rosà T., Spadaro S., Bitondo M.M., Montomoli J., Falò G., Tonetti T., Cutuli S.L., et al. Effect of helmet noninvasive ventilation vs high-flow nasal oxygen on days free of respiratory support in patients with COVID-19 and moderate to severe hypoxemic respiratory failure. JAMA. 2021;325:1731. doi: 10.1001/jama.2021.4682. - DOI - PMC - PubMed