Outcomes of an intermediate respiratory care unit in the COVID-19 pandemic

• Published in: PloS one 2020-12, Vol.15 (12), p.e0243968-e0243968
• Main Authors: Carrillo Hernandez-Rubio, Javier, Sanchez-Carpintero Abad, Maria, Yordi Leon, Andrea, Doblare Higuera, Guillermo, Garcia Rodriguez, Leticia, Garcia Torrejon, Carmen, Mayor Cacho, Alejandro, Jimenez Rodriguez, Angel, Garcia-Salmones Martin, Mercedes
• Format: Article
• Language: English
• Subjects: Acute respiratory distress syndrome; Adult respiratory distress syndrome; Aged; Biology and Life Sciences; Care and treatment; Causes of; Complications; Coronaviruses; COVID-19; COVID-19 - epidemiology; COVID-19 - pathology; COVID-19 - therapy; COVID-19 - virology; Dyspnea; Ethics; Failure rates; Female; Hospitals; Humans; Intensive care; Intubation; Intubation, Intratracheal; Logistic Models; Male; Mechanical ventilation; Medical materials; Medicine; Medicine and Health Sciences; Methods; Middle Aged; Mortality; Pandemics; Patient outcomes; Patients; Polymerase chain reaction; Proportional Hazards Models; Prospective Studies; Regression analysis; Regression models; Respiratory Care Units; Respiratory failure; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; Respiratory intensive care; SARS-CoV-2 - isolation & purification; Severe acute respiratory syndrome coronavirus 2; Spain - epidemiology; Statistical analysis; Supervision; Survival Rate; Tachypnea; Trachea; Treatment Outcome; Tubes; Ventilation; Ventilators
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0243968

15% of COVID-19 patients develop severe pneumonia. Non-invasive mechanical ventilation and high-flow nasal cannula can reduce the rate of endotracheal intubation in adult respiratory distress syndrome, although failure rate is high. To describe the rate of endotracheal intubation, the effectiveness of treatment, complications and mortality in patients with severe respiratory failure due to COVID-19. Prospective cohort study in a first-level hospital in Madrid. Patients with a positive polymerase chain reaction for SARS-CoV-2 and admitted to the Intermediate Respiratory Care Unit with tachypnea, use of accessory musculature or SpO2 0.5 were included. Intubation rate, medical complications, and 28-day mortality were recorded. Statistical analysis through association studies, logistic and Cox regression models and survival analysis was performed. Seventy patients were included. 37.1% required endotracheal intubation, 58.6% suffered medical complications and 24.3% died. Prone positioning was independently associated with lower need for endotracheal intubation (OR 0.05; 95% CI 0.005 to 0.54, p = 0.001). The adjusted HR for death at 28 days in the group of patients requiring endotracheal intubation was 5.4 (95% CI 1.51 to 19.5; p = 0.009). The rate of endotracheal intubation in patients with severe respiratory failure from COVID-19 was 37.1%. Complications and mortality were lower in patients in whom endotracheal intubation could be avoided. Prone positioning could reduce the need for endotracheal intubation.