Outcomes of COVID-19 Patients Admitted to the Intermediate Respiratory Care Unit: Non-Invasive Respiratory Therapy in a Sequential Protocol

HIGHLIGHTS: What are the main findings? In our patient population, 57% of patients improved during an Intermediate Respiratory Care Unit stay without Intensive Care Unit admission. Age and lack of corticosteroid treatment were associated with higher mortality regardless of the severity of hypoxic respiratory failure and the non-invasive therapy applied. What is the implication of the main finding? A rapid respiratory worsening despite maximal non-invasive therapy involves bad outcomes being mandatory not to delay intubation in this scenario. Starting non-invasive ventilation as the first line of non-invasive therapy does not always mean bad outcomes (further intubation). ABSTRACT: The intermediate respiratory care units (IRCUs) have a pivotal role managing escalation and de-escalation between the general wards and the intensive care units (ICUs). Since the COVID-19 pandemic began, the early detection of patients that could improve on non-invasive respiratory therapies (NRTs) in IRCUs without invasive approaches is crucial to ensure proper medical management and optimize limiting ICU resources. The aim of this study was to assess factors associated with survival, ICU admission and intubation likelihood in COVID-19 patients admitted to IRCUs. Observational retrospective study in consecutive patients admitted to the IRCU of a tertiary hospital from March 2020 to April 2021. Inclusion criteria: hypoxemic respiratory failure (SpO(2) ≤ 94% and/or respiratory rate ≥ 25 rpm with FiO(2) > 50% supplementary oxygen) due to acute COVID-19 infection. Demographic, comorbidities, clinical and analytical data, and medical and NRT data were collected at IRCU admission. Multivariate logistic regression models assessed factors associated with survival, ICU admission, and intubation. From 679 patients, 79 patients (12%) had an order to not do intubation. From the remaining 600 (88%), 81% survived, 41% needed ICU admission and 37% required intubation. In the IRCU, 51% required non-invasive ventilation (NIV group) and 49% did not (non-NIV group). Older age and lack of corticosteroid treatment were associated with higher mortality and intubation risk in the scheme, which could be more beneficial in severe forms. Initial NIV does not always mean worse outcomes.