ORIGINAL ARTICLE   Open access

Italian Journal of Emergency Medicine 2020 August;9(2):131-6

DOI: 10.23736/S2532-1285.20.00038-5

Copyright © 2020 THE AUTHORS

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language: English

COVID-19: a single experience in Intermediate Care Unit

Paola V. NOTO ¹ ✉, Chiara M. GIRAFFA ², Elisabetta RAGUSA ², Giuseppe MANGANO ¹, Lorenzo MALATINO ², Giuseppe CARPINTERI ¹

¹ Department of Emergency Medicine, San Marco Polyclinic University Hospital, Catania, Italy; ² Unit of Internal Medicine, Department of Clinical and Experimental Medicine, School of Emergency Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus emerged in December 2019 that spread rapidly worldwide.
METHODS: We retrospective selected data from 30 patients with confirmed COVID-19 infection and acute respiratory failure admitted in Intermediate Care Unit from March 1st to May 31st. Clinical examination, laboratory and radiological findings, setting of noninvasive ventilation an in-hospital mortality during hospitalization were evaluated.
RESULTS: We evaluated 30 patients and confirmed SARS-Co-V2 infection and respiratory failure. The mean age was 65.5 years and 67.7% were male. Seventeen (56.7%) patients were admitted from home and fever was the most frequent symptom at admission. A chest computed tomography was obtained in all patients at admission in Emergency Department and the most common pattern was bilateral ground-glass opacity (80%). Fifteen patients (50%) received C-PAP and the median positive and expiratory pressure (PEEP) during the first three days was 6 to 7 cm of water. Of the 30 patients, 11 required further orotracheal intubation and invasive mechanical ventilation in Intensive Care Unit (ICU). In-hospital mortality rate was 26.7% (8 patients) and higher PEEP was associated with an increased mortality rate.
CONCLUSIONS: Among patients with severe COVID-19 pneumonia, most of them will evolve in acute severe respiratory distress syndrome (ARDS) that require Intensive Care Unit Admission and mechanical ventilation. Recently, Gattinoni reported a typical dissociation between the relatively well-preserved lung mechanics and the severity of hypoxemia and encouraged “the lowest possible PEEP and gentle ventilation” to avoid self-inflicted lung injury in these patients. Our experience with COVID-19 critical ill patients admitted in IMCU that received noninvasive ventilation recommend an early respiratory support with low PEEP.

KEY WORDS: COVID-19; Coronavirus; Noninvasive ventilation; Intermediate care facilities