Role of Respiratory Intermediate Care Units During the SARS-CoV-2 Pandemic

Mónica Matute-Villacís; Jorge Moisés; Cristina Embid; Judith Armas; Isabel Fárnandez; Montserrat Medina; Miquel Ferrer; Oriol Sibila; Joan Ramón Badia

Disclosures

BMC Pulm Med. 2021;21(228) 

In This Article

Abstract and Introduction

Abstract

Rationale: The SARS-CoV2 pandemic increased exponentially the need for both Intensive (ICU) and Intermediate Care Units (RICU). The latter are of particular importance because they can play a dual role in critical and post-critical care of COVID-19 patients. Here, we describe the setup of 2 new RICUs in our institution to face the SARS-CoV-2 pandemic and discuss the clinical characteristics and outcomes of the patients attended.

Methods: Retrospective analysis of the characteristics and outcomes of COVID-19 patients admitted to 2 new RICUs built specifically in our institution to face the first wave of the SARS-CoV-2 pandemic, from April 1 until May 30, 2020.

Results: During this period, 106 COVID-19 patients were admitted to these 2 RICUs, 65 of them (61%) transferred from an ICU (step-down) and 41 (39%) from the ward or emergency room (step-up). Most of them (72%) were male and mean age was 66 ± 12 years. 31% of them required support with oxygen therapy via high-flow nasal cannula (HFNC) and 14% non-invasive ventilation (NIV). 42 of the 65 patients stepping down (65%) had a previous tracheostomy performed and most of them (74%) were successfully decannulated during their stay in the RICU. Length of stay was 7 [4–11] days. 90-day mortality was 19% being significantly higher in stepping up patients than in those transferred from the ICU (25 vs. 10% respectively; p < 0.001).

Conclusions: RICUs are a valuable hospital resource to respond to the challenges of the SARS-CoV-2 pandemic both to treat deteriorating and recovering COVID-19 patients.

Introduction

The outbreak of a novel coronavirus SARS-CoV2 causing COVID-19 (coronavirus disease 2019) has led to an unprecedented international health crisis. On March 11th, the World Health Organization (WHO) declared a global pandemic due to the rapid increase in the number of cases outside China. Since then, healthcare response to the COVID-19 pandemic has been a major concern for public health services and nations around the world.[1]

The high transmissibility of the SARS-CoV-2[2] and the fact that 5–15% of all infected patients will develop severe COVID-19 disease rapidly filled up the available Intensive Care Unit (ICU) beds[3] and led to contingency plans to increase their number by using other ICU beds, such as those normally dedicated to post-operative support (with a parallel reduction in surgical activity) and even to the conditioning of the operating rooms themselves to provide critical care to severe COVID-19. In this scenario, Respiratory Intermediate Care Units (RICU) played an important double role. First, by facilitating the step-down of ICU patients (hence reducing their length of stay in ICU which, in turn, facilitated the care of new critically ill patients), many of them with tracheostomy and ICU-associated myopathy that require expert care including rehabilitation.[4–6] Second, by providing high-flow oxygen therapy via nasal cannula (HFNC) or non-invasive ventilation (NIV) in less severe patients (who may eventually require ICU care too (step-up)) or in those who may not be candidates for mechanical ventilation due to concomitant conditions.[7]

Here, we: (1) describe the setup of 2 new RICUs in our institution to face the SARS-CoV-2 pandemic; and, (2) discuss the clinical characteristics and outcomes of the patients attended there.

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