Uso del soporte respiratorio no invasivo en pacientes con distrés moderado-severo por SARS-CoV-2. Experiencia en un hospital de segundo nivel

Abstract

Objective. To describe the characteristics of the patients admitted to an intermediate respiratory care unit (UCRI) created as a result of the pandemic, to analyze the factors associated with survival and therapeutic ceiling. Material and method. Descriptive observational study, includes all cases with SARS-CoV-2 pneumonia that required admission to UCRI. Variables analyzed: clinical, analytical, therapeutic, survival, respiratory support and oximetric evolution. A univariate analysis was performed for the differences according to therapeutic ceiling and survival at 90 days, for the evolution of SpO2/FiO2 over time, mixed linear models were adjusted. Results. 37 patients participated. The 46% of them were not candidates for critical care. Characteristics significantly associated with the order of non-intubation: older age (p = 0.001), higher Charlson index (p = 0.003), COPD (p = 0.014) or cancer (p = 0.033). Overall survival in UCRI 58%, according to the therapeutic ceiling in non-intubable patients, survival was 41%, while in intubable it was 89%. The variables associated with mortality were older age (p = 0.012), higher charlson index (p = 0.030), higher value of reactive protein C (p = 0.045), lower number of lymphocytes (p = 0.019) and treatment with lopinovir/ritonavir (p = 0.006). The mean SpO2/FiO2 at the beginning of non-invasive respiratory support (SRNI) was 112 (SD: 23), 81% suffered from moderate-severe distress. The lower the initial SpO2/FiO2, the worse the prognosis (p <0.001), the use of NIRS progressively improves the SpO2/FiO2 with the greater number of hours of use (p = 0.006). Conclusions. SRNI in UCRI is safe, improves oxygenation and offers therapeutic options in non-intubable patients.