Clinical Characteristics and Outcomes of Patients with Acute Respiratory Failure Due to SARS-CoV-2 Interstitial Pneumonia Treated with CPAP in a Medical Intermediate Care Setting: A Retrospective Observational Study on Comparison of Four Waves

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 Feb 25

PMID 36836094

Authors

Silvia Accordino

Ciro Canetta

Greta Bettini

Federica Corsico

Gabriele Ghigliazza

Laura Barbetta

Christian Folli

Valeria Savojardo

Francesco Blasi

Affiliations

Soon will be listed here.

Abstract

Background: In COVID-19 patients non-invasive-positive-pressure-ventilation (NIPPV) has held a challenging role to reduce mortality and the need for invasive mechanical ventilation (IMV). The aim of this study was to compare the characteristics of patients admitted to a Medical Intermediate Care Unit for acute respiratory failure due to SARS-CoV-2 pneumonia throughout four pandemic waves.

Methods: The clinical data of 300 COVID-19 patients treated with continuous positive airway pressure (CPAP) were retrospectively analysed, from March-2020 to April-2022.

Results: Non-survivors were older and more comorbid, whereas patients transferred to ICU were younger and had fewer pathologies. Patients were older (from 65 (29-91) years in I wave to 77 (32-94) in IV, < 0.001) and with more comorbidities (from Charlson's Comorbidity Index = 3 (0-12) in I to 6 (1-12) in IV, < 0.001). No statistical difference was found for in-hospital mortality (33.0%, 35.8%, 29.6% and 45.9% in I, II, III and IV, = 0.216), although ICU-transfers rate decreased from 22.0% to 1.4%.

Conclusions: COVID-19 patients have become progressively older and with more comorbidities even in critical care area; from risk class analyses by age and comorbidity burden, in-hospital mortality rates remain high and are thus consistent over four waves while ICU-transfers have significantly reduced. Epidemiological changes need to be considered to improve the appropriateness of care.

Citing Articles

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Motes A, Singh T, Vinan Vega N, Nugent K J Clin Med. 2023; 12(14).

PMID: 37510765 PMC: 10380732. DOI: 10.3390/jcm12144650.

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