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

Annals of Intensive Care

Tommaso Tonetti¹  Giacinto Pizzilli¹  Antonio Pesenti²  Maddalena Giannella³  Michele Bartoletti³  Pierluigi Viale³  Vanni Agnoletti⁴  Giovanni Gordini⁵  Roberto Fumagalli⁶  Giuseppe Foti⁷  Luca Lorini⁸  Simone Piva⁹  Sandra Rossi^1,10  Paolo Navalesi^1,11  Ilaria Valeri^1,11  Alessandro Graziano^1,11  Annalisa Boscolo^1,11  Giorgio Iotti^1,12  Sergio Colombo^1,13  Massimo Girardis^1,14  Anselmo Campagna^1,15  Maurizio Cecconi^1,16  Stefano Nava^1,17  V. Marco Ranieri^1,18  Franco Locatelli^1,19  Massimo Antonelli^2,20  Claudia Filippini^2,21  Danilo Cereda^2,22  Luigi Vivona^2,23  Alberto Zanella^2,24  Giacomo Grasselli^2,24  Andrea Vianello^2,25 

[1] Alma Mater Studiorum, Dipartimento Di Scienze Mediche E Chirurgiche, Anesthesia and Intensive Care Medicine, Università Di Bologna, Policlinico Di Sant’Orsola, Via Massarenti, 9 40138, Bologna, Italy;Alma Mater Studiorum, Dipartimento Di Scienze Mediche E Chirurgiche, Anesthesia and Intensive Care Medicine, Università Di Bologna, Policlinico Di Sant’Orsola, Via Massarenti, 9 40138, Bologna, Italy;Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy;Alma Mater Studiorum, Dipartimento Di Scienze Mediche E Chirurgiche, Infectious Diseases Unit, Università Di Bologna, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy;Anesthesia and Critical Care Ospedale “M. Bufalini”, Cesena, Italy;Anesthesia and Critical Care Ospedale, Ospedale Maggiore, Bologna, Italy;Anesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, University of Milano-Bicocca, Milan, Italy;Anesthesia and Critical Care, ASST Ospedale San Gerardo Di Monza, University of Milano-Bicocca, Milan, Italy;Anesthesia and Critical Care, ASST Papa Giovanni XXIII, Bergamo, Italy;Anesthesia and Critical Care, ASST Spedali Civili, University of Brescia, Brescia, Italy;Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Di Parma, Parma, Italy;Anesthesia and Critical Care, Department of Medicine, DIMED - University of Padua, University Hospital of Padua, Padua, Italy;Anesthesia and Critical Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;Anesthesia and Critical Care, IRCCS San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milan, Italy;Anesthesia and Critical Care, Policlinico Di Modena, Università Di Modena E Reggio Emilia, Modena, Italy;Assessorato Cura Della Persona, Regione Emilia-Romagna, Salute e Walfare, Bologna, Italy;Department of Anesthesia and Intensive Care, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy;Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy;Department of Clinical, Integrated, and Experimental Medicine (DIMES), Respiratory and Critical Care, Sant’Orsola Malpighi Hospital, Bologna, Italy;Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy;Department of Pediatric Hematology and Oncology, Sapienza University of Rome, IRCCS Ospedale Pediatrico Bambino Gesù. President of the “Consiglio Superiore Di Sanità”, Rome, Italy;Dept. of Intensive Care Emergency Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy;Dipartimento Di Scienze Chirurgiche, Università Di Torino, Torino, Italy;Direzione Generale Welfare, Lombardy Region, Milan, Italy;Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy;Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy;Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy;Respiratory Pathophysiology Division University-City Hospital of Padua, Padua, Italy;

关键词: COVID-19;    Acute respiratory failure;    ICU;    Non-invasive ventilation;    Rationing;   

DOI  :  10.1186/s13613-020-00750-z

来源: Springer

【 摘 要 】

BackgroundA 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.ResultsIn 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.ConclusionsIncrease 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.

【 授权许可】

CC BY