An Italian Network for the Management of Severe Covid-19 Disease in Respiratory Intermediate Care Units (Ricu): The Pneumo-Cov-Ven-It.

INTRODUCTION: Evidence on the management of COVID-19 patients with severe acute respiratory failure outside Intensive Care Units (ICU) is limited. To assess mortality, outcomes/complications and their risk factors in COVID-19 patients with bilateral interstitial pneumonia and severe respiratory failure treated in Respiratory Intermediate Care Units (RICU) within an Italian pulmonology network. METHODS: retrospective observational multicentre study was performed collecting data regarding severe respiratory failure due to SARS-CoV-2 bilateral interstitial pneumonia in 13 RICU in the Veneto region from February 2020 to May 2023. RESULTS: A total of 1557 patients were included (median age 69 years; male 71% vs female 29%, p-value=0.009). The most frequent symptoms at ER admission were fever (78%), dyspnoea (72%), and cough (48%). At RICU admission, patients showed severe hypoxemia (median PaO₂/FiO₂ = 140, IQR 100-209). Respiratory support included non-invasive ventilation (NIV) and/or continuous positive airway pressure (CPAP) plus high-flow nasal cannula (HFNC) in 72%, HFNC alone in 12%, and low-flow oxygen in 16%. Overall, in-hospital mortality was 25%; in-RICU mortality was 16%. The 19.7% of patients were transferred to ICU, and 91% of them were intubated. ICU mortality was 51.8%. Independent mortality risk factors included chronic kidney disease (+13%) and diabetes (+7.4%), while mortality decreased significantly during the third pandemic timeframe (p<0.001). Male sex and older age were associated with higher risk of mortality. CONCLUSIONS: This large multicentre study across 2020-2023 demonstrates that RICU management provided favourable outcomes in severe COVID-19, even among elderly and comorbid patients.