Effectiveness of Intermediate Respiratory Care Units as an Alternative to Intensive Care Units during the COVID-19 Pandemic in Catalonia

Abstract

Objectives: During the COVID-19 pandemic, the risk of collapse for the health system created great difficulties. We will demonstrate that intermediate respiratory care units (IRCU) provide adequate management of patients with non-invasive respiratory support, which is particularly important for patients with SARS-CoV-2 pneumonia. Methods: A prospective observational study of patients with COVID-19 admitted to the ICU of a tertiary hospital. Sociodemographic data, comorbidities, pharmacological, respiratory support, laboratory and blood gas variables were collected. The overall cost of the unit was subsequently analyzed. Results: 991 patients were admitted, 56 to the IRCU (from a of 81 admitted to the critical care unit). Mean age was 65 years (SD 12.8), Barthel index 75 (SD 8.3), Charlson comorbidity index 3.1 (SD 2.2), HTN 27%, COPD 89% and obesity 24%. A significant relationship (p < 0.05) with higher mortality was noted for the following parameters: fever greater than or equal to 39 °C [OR 5.6; 95% CI (1.2–2.7); p = 0.020], protocolized pharmacological treatment [OR 0.3; 95% CI (0.1–0.9); p = 0.023] and IOI [OR 3.7; 95% CI (1.1–12.3); p = 0.025]. NIMV had less of a negative impact [OR 1.8; 95% CI (0.4–8.4); p = 0.423] than IOI. The total cost of the IRCU amounted to €66,233. The cost per day of stay in the IRCU was €164 per patient. The total cost avoided was €214,865. Conclusions: The pandemic has highlighted the importance of IRCUs in facilitating the management of a high patient volume. The treatment carried out in IRCUs is effective and efficient, reducing both admissions to and stays in the ICU.

Utility of Intermediate Care Units: A Systematic Review Study

“…Prior to admission ICU, it is essential to manage critically ill patients for the application of specific drugs or procedures that may impact their outcome during the pandemic period [38]. According to Galdeano et al's study, 70% of COVID-19 patients were treated in respiratory IMCUs, highlighting their efficacy as support units [32].…”

“…Additionally, establishing these units decreases the occurrence of premature discharges [3], eliminates the need for transfers to regional hospitals lacking ICUs [18], and minimizes the length of stay in the ICU while still maintaining proper levels of surveillance and monitoring [23] without adversely affecting patient outcomes [17]. Intermediate care units have proven to be a critical asset in managing extremely complicated patients during the COVID-19 outbreak [32,36].…”

“…The crucial role of respiratory IMCUs during the COVID-19 pandemic, which revealed the shortage of ICU beds in the Spanish healthcare system, should be emphasized [32]. As demonstrated by G. Suarez-Cuartin et al, such units enabled the treatment of patients who needed constant monitoring but did not require invasive mechanical ventilation [31], thus preventing almost half of critically ill patients from being admitted to an ICU [37].…”

Unidades de Cuidados Respiratorios Intermedios: preguntas y respuestas

“…Ante este dato, los hospitales se adaptaron y reorganizaron para dar servicio y soporte a estos pacientes mediante la creación o ampliación de UCRI. Aunque existen datos contradictorios en referencia al impacto sobre los pacientes y los datos económicos de las UCRI, sobre todo por la gravedad de los pacientes valorados y la complejidad del análisis de la utilidad 19 , recientemente se han publicado datos de coste-efectividad en el seno de la pandemia, de tal manera que el desarrollo de las terapias de soporte respiratorio no invasivo y la disminución de los gastos asociados a una unidad de mayor monitorización en la que las terapias son invasivas, se ha estimado en el ahorro de 214.865 € en una UCRI de Cataluña 29 .…”