Feasibility and clinical impact of out-of-ICU noninvasive respiratory support in patients with COVID-19-related pneumonia.

Aged Aged, 80 and over Betacoronavirus COVID-19 Cohort Studies Coronavirus Infections / complications Critical Care Feasibility Studies Female Hospital Mortality Humans Length of Stay Male Middle Aged Noninvasive Ventilation Pandemics Pneumonia, Viral / complications SARS-CoV-2

Journal

The European respiratory journal
ISSN: 1399-3003
Titre abrégé: Eur Respir J
Pays: England
ID NLM: 8803460

Informations de publication

Date de publication:
Nov 2020
Historique:
received: 03 06 2020
accepted: 27 07 2020
pubmed: 5 8 2020
medline: 27 11 2020
entrez: 5 8 2020
Statut: epublish

Résumé

The severe acute respiratory syndrome-coronavirus 2 outbreak spread rapidly in Italy and the lack of intensive care unit (ICU) beds soon became evident, forcing the application of noninvasive respiratory support (NRS) outside the ICU, raising concerns over staff contamination. We aimed to analyse the safety of the hospital staff and the feasibility and outcomes of NRS applied to patients outside the ICU. In this observational study, data from 670 consecutive patients with confirmed coronavirus disease 2019 referred to pulmonology units in nine hospitals between March 1 and May 10, 2020 were analysed. Data collected included medication, mode and usage of NRS ( 42 (11.1%) healthcare workers tested positive for infection, but only three of them required hospitalisation. Data are reported for all patients (69.3% male), whose mean±sd age was 68±13 years. The arterial oxygen tension/inspiratory oxygen fraction ratio at baseline was 152±79, and the majority (49.3%) of patients were treated with CPAP. The overall unadjusted 30-day mortality rate was 26.9%, with 16%, 30% and 30% for HFNC, CPAP and NIV, respectively, while the total ETI rate was 27%, with 29%, 25% and 28%, respectively; the relative probability of death was not related to the NRS used after adjustment for confounders. ETI and length of stay were not different among the groups. Mortality rate increased with age and comorbidity class progression. The application of NRS outside the ICU is feasible and associated with favourable outcomes. Nonetheless, it was associated with a risk of staff contamination.

Identifiants

DOI: 10.1183/13993003.02130-2020 PMID: 32747398 PMC: PMC7397952
pubmed: 32747398
pii: 13993003.02130-2020
doi: 10.1183/13993003.02130-2020
pmc: PMC7397952
pii:
doi:

Types de publication

Journal Article Observational Study

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright ©ERS 2020.

Déclaration de conflit d'intérêts

Conflict of interest: C. Franco has nothing to disclose. Conflict of interest: N. Faccialongo has nothing to disclose. Conflict of interest: R. Tonelli has nothing to disclose. Conflict of interest: R. Dongilli has nothing to disclose. Conflict of interest: A. Vianello has nothing to disclose. Conflict of interest: L. Pisani has nothing to disclose. Conflict of interest: R. Scala has nothing to disclose. Conflict of interest: M. Malerba has nothing to disclose. Conflict of interest: A. Carlucci has nothing to disclose. Conflict of interest: E.A. Negri has nothing to disclose. Conflict of interest: G. Spoladore has nothing to disclose. Conflict of interest: G. Arcaro has nothing to disclose. Conflict of interest: P.A. Tillio has nothing to disclose. Conflict of interest: C. Lastoria has nothing to disclose. Conflict of interest: G. Schifino has nothing to disclose. Conflict of interest: L. Tabbì has nothing to disclose. Conflict of interest: L. Guidelli has nothing to disclose. Conflict of interest: G. Guaraldi has nothing to disclose. Conflict of interest: V.M. Ranieri has nothing to disclose. Conflict of interest: E. Clini has nothing to disclose. Conflict of interest: S. Nava has nothing to disclose.

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Auteurs

Cosimo Franco (C)

Respiratory Intensive Care Unit - AUSL, Piacenza, Italy.
Contributed equally to the work and should both be considered as first author.

Nicola Facciolongo (N)

Respiratory Unit AUSL Reggio Emilia, IRCCS di Reggio Emilia, Modena, Italy.
Contributed equally to the work and should both be considered as first author.

Roberto Tonelli (R)

Clinical and Experimental Medicine PhD Programme, University of Modena Reggio Emilia, Modena, Italy.
University Hospital of Modena, Respiratory Diseases Unit, Dept of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy.

Roberto Dongilli (R)

Division of Respiratory Diseases with Intermediate Respiratory Intensive Care Units, Central Hospital of Bolzano, Bolzano, Italy.

Andrea Vianello (A)

Respiratory Pathophysiology Division University of Padova, Padova, Italy.
ORCID: 0000-0002-8790-6029

Lara Pisani (L)

Respiratory and Critical Care Unit, Sant'Orsola Hospital, Bologna Dept of Specialist, Diagnostic, and Experimental Medicine, School of Medicine, University di Bologna, Bologna, Italy.

Raffaele Scala (R)

Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy.

Mario Malerba (M)

Dept of Translational Medicine, Università Piemonte Orientale, Respiratory Unit, Ospedale S. Andrea, Vercelli, Italy.

Annalisa Carlucci (A)

Dipartimento di Medicina e Chirurgia, Università Insubria Varese-Como, ICS Maugeri, Pavia, Italy.

Emanuele Alberto Negri (EA)

Respiratory Unit AUSL Reggio Emilia, IRCCS di Reggio Emilia, Modena, Italy.

Greta Spoladore (G)

Division of Infectious Diseases, Central Hospital of Bolzano, Bolzano, Italy.

Giovanna Arcaro (G)

Respiratory Pathophysiology Division University of Padova, Padova, Italy.

Paolo Amedeo Tillio (PA)

Dept of Translational Medicine, Università Piemonte Orientale, Respiratory Unit, Ospedale S. Andrea, Vercelli, Italy.

Cinzia Lastoria (C)

Respiratory Rehabilitation Unit, ICS Maugeri, Pavia, Italy.

Gioachino Schifino (G)

Respiratory and Critical Care Unit, Sant'Orsola Hospital, Bologna Dept of Specialist, Diagnostic, and Experimental Medicine, School of Medicine, University di Bologna, Bologna, Italy.

Luca Tabbì (L)

University Hospital of Modena, Respiratory Diseases Unit, Dept of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy.

Luca Guidelli (L)

Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy.

Giovanni Guaraldi (G)

Infectious Diseases Unit, University Hospital of Modena Policlinico. University of Modena Reggio Emilia, Modena, Italy.

V Marco Ranieri (VM)

Alma Mater Studiorum - Università di Bologna, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Bologna, Italy.

Enrico Clini (E)

University Hospital of Modena, Respiratory Diseases Unit, Dept of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy.
Contributed equally to the work and should both be considered as senior author.
ORCID: 0000-0002-1515-5094

Stefano Nava (S)

Alma Mater Studiorum - Università di Bologna, Dipartimento di Scienze Mediche e Chirurgiche, Infectious Diseases Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Contributed equally to the work and should both be considered as senior author.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Feasibility and clinical impact of out-of-ICU...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Feasibility and clinical impact of out-of-ICU...
questionsmedicales.fr › Virus › Virus à ARN › Virus à ARN à brin positif › Nidovirales › Coronaviridae › Coronavirus › Betacoronavirus › Feasibility and clinical impact of out-of-ICU...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Pneumopathie infectieuse › Pneumopathie virale › COVID-19 › Feasibility and clinical impact of out-of-ICU...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Feasibility and clinical impact of out-of-ICU...
questionsmedicales.fr › Infection › Maladies virales › Infections à virus à ARN › Infections à Nidovirales › Infections à Coronaviridae › Infections à coronavirus › Feasibility and clinical impact of out-of-ICU...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Soins de réanimation › Feasibility and clinical impact of out-of-ICU...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études de faisabilité › Feasibility and clinical impact of out-of-ICU...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Mortalité › Mortalité hospitalière › Feasibility and clinical impact of out-of-ICU...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Feasibility and clinical impact of out-of-ICU...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Durée du séjour › Feasibility and clinical impact of out-of-ICU...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Feasibility and clinical impact of out-of-ICU...
questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Ventilation artificielle › Ventilation non effractive › Feasibility and clinical impact of out-of-ICU...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Épidémies de maladies › Épidémies › Pandémies › Feasibility and clinical impact of out-of-ICU...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Pneumopathie infectieuse › Pneumopathie virale › Feasibility and clinical impact of out-of-ICU...
questionsmedicales.fr › Virus › Virus à ARN › Virus à ARN à brin positif › Nidovirales › Coronaviridae › Coronavirus › Betacoronavirus › Virus du SRAS › SARS-CoV-2 › Feasibility and clinical impact of out-of-ICU...