Abstract and Introduction
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.
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.
The high transmissibility of the SARS-CoV-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 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.
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.
BMC Pulm Med. 2021;21(228) © 2021 BioMed Central, Ltd.