Abstract
15% of COVID-19 patients develop severe pneumonia. Non-invasive mechanical ventilation and high-flow nasal cannula can reduce the rate of endotracheal intubation in adult respiratory distress syndrome, although failure rate is high. To describe the rate of endotracheal intubation, the effectiveness of treatment, complications and mortality in patients with severe respiratory failure due to COVID-19. Prospective cohort study in a first-level hospital in Madrid. Patients with a positive polymerase chain reaction for SARS-CoV-2 and admitted to the Intermediate Respiratory Care Unit with tachypnea, use of accessory musculature or SpO2 <92% despite FiO2> 0.5 were included. Intubation rate, medical complications, and 28-day mortality were recorded. Statistical analysis through association studies, logistic and Cox regression models and survival analysis was performed. Seventy patients were included. 37.1% required endotracheal intubation, 58.6% suffered medical complications and 24.3% died. Prone positioning was independently associated with lower need for endotracheal intubation (OR 0.05; 95% CI 0.005 to 0.54, p = 0.001). The adjusted HR for death at 28 days in the group of patients requiring endotracheal intubation was 5.4 (95% CI 1.51 to 19.5; p = 0.009). The rate of endotracheal intubation in patients with severe respiratory failure from COVID-19 was 37.1%. Complications and mortality were lower in patients in whom endotracheal intubation could be avoided. Prone positioning could reduce the need for endotracheal intubation.
Highlights
On March 11, 2020, the World Health Organization declared the novel COVID-19 outbreak a global pandemic [1]
Prone positioning was independently associated with lower need for endotracheal intubation
Complications and mortality were lower in patients in whom endotracheal intubation could be avoided
Summary
On March 11, 2020, the World Health Organization declared the novel COVID-19 outbreak a global pandemic [1]. More than three million cases had been reported worldwide by the end of the first week in May, of which 221,000 had been declared in Spain [2] The spectrum of this disease caused by the SARS-CoV-2 coronavirus ranges from a common cold to a severe pneumonia defined according to American Thoracic Society criteria [3] in a not negligible 15% of patients [4]. The rapid increase in the incidence of COVID-19 and consequent saturation of the capacity of the intensive care units (ICUs) led to a significant role for intermediate respiratory care units (IRCUs) in the management of these patients, with the principal purpose of reducing the need for endotracheal intubation (ETI) using non-invasive respiratory support. The importance of adequate selection of patients and early access to ETI in the absence of response
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
