Effectiveness of Intermediate Respiratory Care Units as an Alternative to Intensive Care Units during the COVID-19 Pandemic in Catalonia

Marina Galdeano Lozano, Julio César Alfaro Álvarez, Núria Parra Macías, Rosario Salas Campos, Sarah Heili Frades, Josep Maria Montserrat, Antoni Rosell Gratacós, Jorge Abad Capa, Olga Parra Ordaz and Francesc López Seguí
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Marina Galdeano Lozano: Unidad de Ventilación y Cuidados Respiratorios Intermedios, Servicio de Neumología, Direcció Clínica Àrea del Tórax, Hospital Universitari Germans Trias i Pujol, IGTP, Universitat Autónoma de Barcelona, Reseau Europén de Recherche en Ventilation Artificielle (REVA), 08193 Barcelona, Spain
Julio César Alfaro Álvarez: Servicio de Neumología, Hospital de Viladecans, 08840 Barcelona, Spain
Núria Parra Macías: Unidad de Innovación Clínica y Promoción de la Salud, Hospital Universitario Sagrat Cor, Grupo Quirón Salud, 08029 Barcelona, Spain
Rosario Salas Campos: Servicio de Medicina Interna, Hospital Universitario Sagrat Cor, Quirón Salud, 08029 Barcelona, Spain
Sarah Heili Frades: Unidad de Cuidados Intermedios Respiratorios, Hospital Fundación Jimenez Díaz, Grupo Quirón Salud, Reseau Europén de Recherche en Ventilation Artificielle, 28040 Madrid, Spain
Josep Maria Montserrat: Unidad del Sueño, Servicio de Neumología, Hospital Clínic Provincial Barcelona, Universitat de Barcelona, 08193 Barcelona, Spain
Antoni Rosell Gratacós: Servicio de Neumología, Direcció Clínica Àrea del Tórax, Hospital Universitari Germans Trias i Pujol, IGTP, Universitat Autónoma de Barcelona, 08193 Barcelona, Spain
Jorge Abad Capa: Servicio de Neumología, Direcció Clínica Àrea del Tórax, Hospital Universitari Germans Trias i Pujol, IGTP, Universitat Autónoma de Barcelona, 08193 Barcelona, Spain
Olga Parra Ordaz: Doctorat de Medicina i Recerca Translacional, Facultat de Medicina, Universitat de Barcelona, 08193 Barcelona, Spain
Francesc López Seguí: Unidad de Economía de la Salud, Dirección de Innovación de la Gerencia Territorial Metropolitana Norte, Institut Català de la Salut, 08007 Barcelona, Spain

IJERPH, 2022, vol. 19, issue 10, 1-11

Abstract: Objectives: During the COVID-19 pandemic, the risk of collapse for the health system created great difficulties. We will demonstrate that intermediate respiratory care units (IRCU) provide adequate management of patients with non-invasive respiratory support, which is particularly important for patients with SARS-CoV-2 pneumonia. Methods: A prospective observational study of patients with COVID-19 admitted to the ICU of a tertiary hospital. Sociodemographic data, comorbidities, pharmacological, respiratory support, laboratory and blood gas variables were collected. The overall cost of the unit was subsequently analyzed. Results: 991 patients were admitted, 56 to the IRCU (from a of 81 admitted to the critical care unit). Mean age was 65 years (SD 12.8), Barthel index 75 (SD 8.3), Charlson comorbidity index 3.1 (SD 2.2), HTN 27%, COPD 89% and obesity 24%. A significant relationship ( p < 0.05) with higher mortality was noted for the following parameters: fever greater than or equal to 39 °C [OR 5.6; 95% CI (1.2–2.7); p = 0.020], protocolized pharmacological treatment [OR 0.3; 95% CI (0.1–0.9); p = 0.023] and IOI [OR 3.7; 95% CI (1.1–12.3); p = 0.025]. NIMV had less of a negative impact [OR 1.8; 95% CI (0.4–8.4); p = 0.423] than IOI. The total cost of the IRCU amounted to €66,233. The cost per day of stay in the IRCU was €164 per patient. The total cost avoided was €214,865. Conclusions: The pandemic has highlighted the importance of IRCUs in facilitating the management of a high patient volume. The treatment carried out in IRCUs is effective and efficient, reducing both admissions to and stays in the ICU.

Keywords: respiratory care; COVID; ICU; cost-effectiveness (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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