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ORIGINAL ARTICLE   Open accessopen access

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

DOI: 10.23736/S2532-1285.20.00038-5

Copyright © 2020 THE AUTHORS

This is an open access article distributed under the terms of the CC BY-NC-ND 4.0 license which allows users to copy and distribute the manuscript, as long as this is not done for commercial purposes and further does not permit distribution of the manuscript if it is changed or edited in any way, and as long as the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI) and provides a link to the license.

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

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