Elsevier

Respiratory Investigation

Volume 59, Issue 5, September 2021, Pages 602-607
Respiratory Investigation

Original article
Risk factors for transfer from Respiratory Intermediate Care Unit to Intensive Care Unit in COVID-19

https://doi.org/10.1016/j.resinv.2021.05.002Get rights and content

Abstract

Background

Patients hospitalized for COVID-19-related pneumonia often need several degrees of ventilatory support, which are performed between Respiratory Intermediate Care Units (RICUs) and Intensive Care Units (ICUs), and which depend on the severity of acute respiratory distress syndrome. There is no firm consensus on transfer predictors from the RICU to the ICU.

Methods

In this retrospective observational single center study, we evaluated 96 COVID-19 patients referred to the RICU for acute respiratory failure (ARF) according to their transferal to the ICU or their stay at the RICU. We compared demographic data, baseline laboratory profile, and final clinical outcomes to identify early risk factors for transfer.

Results

The best predictors for transfer to the ICU were elevated C-reactive protein and lymphopenia. The mortality rate was lower in the RICU than in the ICU, where transferred patients who died were mostly younger men and with less comorbidities than those in the RICU.

Conclusions

Few inflammatory markers can predict the need for transfer from the RICU to the ICU. Due to the ongoing COVID-19 pandemic, we urge better clinical stratification by early and meaningful profiles in patients admitted to the RICU who are at risk of transferal to the ICU.

Keywords

COVID-19
COVID-19 management Italy
COVID-19 ICU transfer risk factors
Respiratory intermediate care unit

Abbreviations

COVID-19
coronavirus disease
RICU
Respiratory Intermediate Care Units
ICU
Intensive Care Unit
IQR
interquartile range
HR
hazard ratio
BMI
body mass index
CCI
Charlson comorbidity index
COPD
Chronic obstructive pulmonary disease
LDH
Lactate dehydrogenase
CRP
C-reactive protein
PaO2/FiO2 ratio
arterial oxygen partial pressure to fractional inspired oxygen
HFNC
high-flow nasal cannula
CPAP
continuous positive airway pressure
BPAP
bilevel positive airway pressure
IMV
invasive mechanical ventilation

Cited by (0)

1

Enrico Buonamico and Vitaliano Nicola Quaranta contributed equally.

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