Use of critical care resources during the first 2 weeks (February 24–March 8, 2020) of the Covid-19 outbreak in Italy

Abstract

Background A Covid-19 outbreak developed in Lombardy, Veneto and Emilia-Romagna (Italy) at the end of February 2020. Fear of an imminent saturation of available ICU beds generated the notion that rationing of intensive care resources could have been necessary. Results In order to evaluate the impact of Covid-19 on the ICU capacity to manage critically ill patients, we performed a retrospective analysis of the first 2 weeks of the outbreak (February 24–March 8). Data were collected from regional registries and from a case report form sent to participating sites. ICU beds increased from 1545 to 1989 (28.7%), and patients receiving respiratory support outside the ICU increased from 4 (0.6%) to 260 (37.0%). Patients receiving respiratory support outside the ICU were significantly older [65 vs. 77 years], had more cerebrovascular (5.8 vs. 13.1%) and renal (5.3 vs. 10.0%) comorbidities and less obesity (31.4 vs. 15.5%) than patients admitted to the ICU. PaO2/FiO2 ratio, respiratory rate and arterial pH were higher [165 vs. 244; 20 vs. 24 breath/min; 7.40 vs. 7.46] and PaCO2 and base excess were lower [34 vs. 42 mmHg; 0.60 vs. 1.30] in patients receiving respiratory support outside the ICU than in patients admitted to the ICU, respectively. Conclusions Increase in ICU beds and use of out-of-ICU respiratory support allowed effective management of the first 14 days of the Covid-19 outbreak, avoiding resource rationing.

Prognostic Accuracy of Early Warning Scores for Clinical Deterioration in Patients With COVID-19

“…Fever was the most common symptom (86.2%), followed by fatigue (85.3%), cough (69.0%), and dyspnea (56.9%). The baseline NEWS, NEWS-C, NEWS2, HEWS, MEWS, and qSOFA at admission were 5 [3,7], 6 [5,9], 6 [5,8], 3 [2,5], 2 [2,3], and 1 [0, 1], respectively. The distributions of all patients by NEWS, NEWS-C, NEWS2, HEWS, MEWS, and qSOFA at admission were presented in Figure 1.…”

“…With a sharp increase in the number of cases and limited medical resources, healthcare systems worldwide are facing unprecedented challenges ( 3 ). Although the majority of patients with COVID-19 have mild symptoms, patients with advanced age and chronic comorbidities such as hypertension tend to have poor outcomes ( 4 , 5 ).…”

Development of a Critical Care Response - Experiences from Italy During the Coronavirus Disease 2019 Pandemic

“…Patients located out of the ICU, compared to within the ICU, had more comorbidities, received more oxygen therapy and NIV, (with the exception of cPAP that did not differ between the 2 groups), had higher PaO 2 /FiO 2 and pH, and lower respiratory rate, paCO 2 and base excess. 3 …”

“…A total of 805 patients were admitted and treated in the ICU among 6378 patients hospitalized for COVID-19 in the period between February 24th– March 8 th , 2020. 3 The coordination of a critical care response in Italy happened in collaboration with out-of-hospital, and out-of-ICU management of patients with respiratory failure.…”

Triage policy of severe Covid-19 patients: what to do now?

“…We have read with great interest the paper of Dr. Tonetti and colleagues in which they describe the response of the critical care departments of the North Italian hospitals of Lombardy, Veneto and Emilia Romagna in the first 2 weeks of the COVID-19 outbreak in their country, relating this to patient outcome data [ 1 ]. ICU departments were expanded by 30% creating 'new' ICU beds by conversion of operation theatres, step-down units and coronary care units.…”