Development of a Non-Invasive Respiratory Support Pathway in COVID19 patients with severe respiratory failure in an Intermediate Respiratory Care Unit

ABSTRACT

The respiratory failure caused by COVID19 and the need to provide non-invasive respiratory support (NIRS) and invasive mechanical ventilation (IMV) has saturated the Intensive Care Units (ICU). In our hospital, an Intermediate Respiratory Care Unit (IMCU) and a protocol (Figure 1) were created to coordinate escalation to NIRS and referral to ICU. The aim of this study was to evaluate the result of implementing this protocol in the IMCU. Retrospective observational cohort study between May 2021 to January 2022, included 174 patients with need NIRS in IMCU (143 receiving HFNC, 23 combining CPAP/HFNC and 8 BIPAP/HFNC). 141 met requirements for cardiopulmonary resuscitation (CPR). The average age was 60 +/-16 years, 67% (117) were male. The median stay in IMCU was 10.5 [8,15] days, requiring NIRS a median of 5 [3,8] days. 39 patients were transferred to the ICU and 28% (11) required IMV in a mean of 3 +/- 2 days after transfer. The mortality rate among patients CPR was 4% (6/141). Prior to the creation of the IMCU 3,172 COVID+ patients were admitted, with a mortality of 20.3%. 10% were admitted to the ICU due to HFNC or NIV requirements, with a mortality rate of 32.5%. This study supports the clinical benefit of creating an IMCU in collaboration with ICU, achieving low mortality rates by monitoring and providing NIRS in COVID19 patients with severe respiratory failure. (Figure Presented).