Use of non-invasive respiratory supports in high-intensity internal medicine setting during the first two waves of the COVID-19 pandemic emergency in Italy: a multicenter, real-life experience.


Journal

Internal and emergency medicine
ISSN: 1970-9366
Titre abrégé: Intern Emerg Med
Pays: Italy
ID NLM: 101263418

Informations de publication

Date de publication:
09 2023
Historique:
received: 14 02 2023
accepted: 03 07 2023
medline: 18 9 2023
pubmed: 20 7 2023
entrez: 20 7 2023
Statut: ppublish

Résumé

During the first two waves of the COVID-19 emergency in Italy, internal medicine high-dependency wards (HDW) have been organized to manage patients with acute respiratory failure (ARF). There is heterogeneous evidence about the feasibility and outcomes of non-invasive respiratory supports (NIRS) in settings outside the intensive care unit (ICU), including in patients deemed not eligible for intubation (i.e., with do-not-intubate, DNI status). Few data are available about the different NIRS modalities applied to ARF patients in the newly assembled internal medicine HDW. The main aim of our study was to describe a real-life experience in this setting of cure, focusing on feasibility and outcomes. We retrospectively collected data from COVID-19 patients with ARF needing NIRS and admitted to internal medicine HDW. Patients were treated with different modalities, that is high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), or non-invasive mechanical ventilation (NIMV). Switching among different NIRS during the hospitalization and the success rate (weaning with the same NIRS) or failure (endotracheal intubation-ETI or in-hospital death) were recorded. Three hundred thirty four ARF patients (median age 74 years), of which 158 (54%) had a DNI status, were included. CPAP, NIMV, and HFNC's success rates were 54, 33, and 13%, respectively. Although DNI status was strongly associated with death (Gehan-Breslow-Wilcoxon test p < 0.001), an acceptable success rate was observed in these patients using CPAP (47%). Multivariate regression models showed older age (odds ratio-OR 4.74), chronic ischemic heart disease (OR 2.76), high respiratory rate after 24 h (OR 7.13), and suspected acute respiratory distress syndrome-ARDS (OR 21.1) as predictors of mortality risk or ETI. Our real-life experience shows that NIRS was feasible in internal medicine HDW with an acceptable success rate. Although DNI patients had a worse prognosis, the use of NIRS represented a reasonable chance of treatment.

Identifiants

pubmed: 37470891
doi: 10.1007/s11739-023-03371-z
pii: 10.1007/s11739-023-03371-z
pmc: PMC10504094
doi:

Types de publication

Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1777-1787

Informations de copyright

© 2023. The Author(s).

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Auteurs

Ernesto Crisafulli (E)

Department of Medicine, Respiratory Medicine Unit and Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Largo L. A. Scuro, 10, 37124, Verona, Italy. ernesto.crisafulli@univr.it.
Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy. ernesto.crisafulli@univr.it.

Giulia Sartori (G)

Department of Medicine, Respiratory Medicine Unit and Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Largo L. A. Scuro, 10, 37124, Verona, Italy.
Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.

Alice Vianello (A)

Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.

Alessio Maroccia (A)

Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.

Elisa Lepori (E)

Internal Medicine, L.Sacco Hospital, ASST-FBF-Sacco, Milan, Italy.

Massimiliano Quici (M)

Internal Medicine, L.Sacco Hospital, ASST-FBF-Sacco, Milan, Italy.

Chiara Cogliati (C)

Internal Medicine, L.Sacco Hospital, ASST-FBF-Sacco, Milan, Italy.
Department of Biochemical and Clinical Sciences, University of Milan, Milan, Italy.

Massimo Salvetti (M)

Dipartimento Di Scienze Cliniche E Sperimentali, Università Di Brescia, Brescia, Italy.
SSVD Medicina Di Urgenza ASST Spedali Civili Brescia, Brescia, Italy.

Anna Paini (A)

SSVD Medicina Di Urgenza ASST Spedali Civili Brescia, Brescia, Italy.

Carlo Aggiusti (C)

SSVD Medicina Di Urgenza ASST Spedali Civili Brescia, Brescia, Italy.

Fabio Bertacchini (F)

SSVD Medicina Di Urgenza ASST Spedali Civili Brescia, Brescia, Italy.

Fabiana Busti (F)

Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.

Giacomo Marchi (G)

Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.

Maria Lorenza Muiesan (ML)

Dipartimento Di Scienze Cliniche E Sperimentali, Università Di Brescia, Brescia, Italy.
UOC 2° Medicina Generale ASST Spedali Civili Brescia, Brescia, Italy.

Domenico Girelli (D)

Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.

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