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.

Use of critical care resources during the first 2 weeks (February 24-March 8, 2020) of the Covid-19 outbreak in Italy / Tonetti, T.; Grasselli, G.; Zanella, A.; Pizzilli, G.; Fumagalli, R.; Piva, S.; Lorini, L.; Iotti, G.; Foti, G.; Colombo, S.; Vivona, L.; Rossi, S.; Girardis, M.; Agnoletti, V.; Campagna, A.; Gordini, G.; Navalesi, P.; Boscolo, A.; Graziano, A.; Valeri, I.; Vianello, A.; Cereda, D.; Filippini, C.; Cecconi, M.; Locatelli, F.; Bartoletti, M.; Giannella, M.; Viale, P.; Antonelli, M.; Nava, S.; Pesenti, A.; Ranieri, V. M.; Albano, G.; Alborghetti, A.; Aldegheri, G.; Antonini, B.; Belgiorno, N.; Bellani, G.; Beretta, E.; Bonazzi, S.; Borelli, M.; Cabrini, L.; Carnevale, L.; Carnevale, S.; Castelli, G.; Catena, E.; Chiumello, D.; Coluccello, A.; Coppini, D.; Covello, D.; Defilippi, G.; Deipoli, M.; Dughi, P.; Gallioli, G.; Gnesin, P.; Greco, S.; Guatteri, L.; Guzzon, D.; Keim, R.; Landoni, G.; Langer, T.; Lombardo, A.; Marino, G.; Merli, G.; Merlo, D.; Mojoli, F.; Muttini, S.; Natalini, G.; Petrucci, N.; Pezzi, A.; Radrizzani, D.; Raimondi, M.; Riccio, M.; Storti, E.; Tavola, M.; Vitale, G.; Bosco, E.; Calo, M. A.; Danzi, V.; Derosa, S.; Farnia, A.; Lazzari, F.; Meggiolaro, M.; Munari, M.; Saia, M.; Sella, N.; Serra, E.; Tiberio, I.; Baiocchi, M.; Benedetto, M.; Bordini, M.; Caramelli, F.; Cilloni, N.; Dellagiovampaola, M.; Fanelli, A.; Frascaroli, G.; Fusari, M.; Gordini, G.; Maitan, S.; Martino, C.; Melotti, R. M.; Merola, R.; Minardi, F.; Moro, F.; Nardi, G.; Nolli, M.; Pierucci, E.; Potalivo, A.; Repetti, F.; Salsi, P.; Terzitta, M.; Tosi, M.; Venturi, S.; Volta, C. A.; Zani, G.; Zanoni, A.. - In: ANNALS OF INTENSIVE CARE. - ISSN 2110-5820. - 10:1(2020). [10.1186/s13613-020-00750-z]

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

Locatelli F.;
2020

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.
2020
acute respiratory failure; COVID-19; ICU; non-invasive ventilation; rationing
01 Pubblicazione su rivista::01a Articolo in rivista
Use of critical care resources during the first 2 weeks (February 24-March 8, 2020) of the Covid-19 outbreak in Italy / Tonetti, T.; Grasselli, G.; Zanella, A.; Pizzilli, G.; Fumagalli, R.; Piva, S.; Lorini, L.; Iotti, G.; Foti, G.; Colombo, S.; Vivona, L.; Rossi, S.; Girardis, M.; Agnoletti, V.; Campagna, A.; Gordini, G.; Navalesi, P.; Boscolo, A.; Graziano, A.; Valeri, I.; Vianello, A.; Cereda, D.; Filippini, C.; Cecconi, M.; Locatelli, F.; Bartoletti, M.; Giannella, M.; Viale, P.; Antonelli, M.; Nava, S.; Pesenti, A.; Ranieri, V. M.; Albano, G.; Alborghetti, A.; Aldegheri, G.; Antonini, B.; Belgiorno, N.; Bellani, G.; Beretta, E.; Bonazzi, S.; Borelli, M.; Cabrini, L.; Carnevale, L.; Carnevale, S.; Castelli, G.; Catena, E.; Chiumello, D.; Coluccello, A.; Coppini, D.; Covello, D.; Defilippi, G.; Deipoli, M.; Dughi, P.; Gallioli, G.; Gnesin, P.; Greco, S.; Guatteri, L.; Guzzon, D.; Keim, R.; Landoni, G.; Langer, T.; Lombardo, A.; Marino, G.; Merli, G.; Merlo, D.; Mojoli, F.; Muttini, S.; Natalini, G.; Petrucci, N.; Pezzi, A.; Radrizzani, D.; Raimondi, M.; Riccio, M.; Storti, E.; Tavola, M.; Vitale, G.; Bosco, E.; Calo, M. A.; Danzi, V.; Derosa, S.; Farnia, A.; Lazzari, F.; Meggiolaro, M.; Munari, M.; Saia, M.; Sella, N.; Serra, E.; Tiberio, I.; Baiocchi, M.; Benedetto, M.; Bordini, M.; Caramelli, F.; Cilloni, N.; Dellagiovampaola, M.; Fanelli, A.; Frascaroli, G.; Fusari, M.; Gordini, G.; Maitan, S.; Martino, C.; Melotti, R. M.; Merola, R.; Minardi, F.; Moro, F.; Nardi, G.; Nolli, M.; Pierucci, E.; Potalivo, A.; Repetti, F.; Salsi, P.; Terzitta, M.; Tosi, M.; Venturi, S.; Volta, C. A.; Zani, G.; Zanoni, A.. - In: ANNALS OF INTENSIVE CARE. - ISSN 2110-5820. - 10:1(2020). [10.1186/s13613-020-00750-z]
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