An Italian Network for the Management of Severe COVID-19 Disease in Respiratory Intermediate Care Units: The...

Evidence on the management of COVID-19 patients with severe acute respiratory failure outside intensive care units (ICUs) is limited. The aim of the study was to assess mortality, outcomes/complications and their risk factors in COVID-19 patients with bilateral interstitial pneumonia and severe respiratory failure treated in respiratory intermediate care units (RICUs) within an Italian pulmonology network.

Retrospective observational multicentre study was performed collecting data regarding severe respiratory failure due to SARS-CoV-2 bilateral interstitial pneumonia in 13 RICU in the Veneto region from February 2020 to May 2023.

A total of 1,557 patients were included (median age 69 years; male 71% vs. female 29%, p value = 0.009). The most frequent symptoms at ER admission were fever (78%), dyspnoea (72%), and cough (48%). At RICU admission, patients showed severe hypoxaemia (median PaO₂/FiO₂ = 140, IQR 100-209). Respiratory support included non-invasive ventilation and/or continuous positive airway pressure plus high-flow nasal cannula (HFNC) in 72%, HFNC alone in 12%, and low-flow oxygen in 16%. Overall, in-hospital mortality was 25%; in-RICU mortality was 16%. The 19.7% of patients were transferred to ICU, and 91% of them were intubated. ICU mortality was 51.8%. Independent mortality risk factors included chronic kidney disease (+13%) and diabetes (+7.4%), while mortality decreased significantly during the third pandemic time frame (p < 0.001). Male sex and older age were associated with higher risk of mortality.

This large multicentre study across 2020-2023 demonstrates that RICU management provided favourable outcomes in severe COVID-19, even among elderly and comorbid patients.