Background 15% of COVID-19 patients develop severe pneumonia. Non-invasive mechanical ventilation and high-flow nasal cannula can reduce the rate of endotracheal intubation in adult respiratory distress syndrome, although failure rate is high. Objective To describe the rate of endotracheal intubation, the effectiveness of treatment, complications and mortality in patients with severe respiratory failure due to COVID-19. Methods Prospective cohort study in a first-level hospital in Madrid. Patients with a positive polymerase chain reaction for SARS-CoV-2 and admitted to the Intermediate Respiratory Care Unit with tachypnea, use of accessory musculature or Sp O2 <92% despite Fi O2 > 0.5 were included. Intubation rate, medical complications, and 28-day mortality were recorded. Statistical analysis through association studies, logistic and Cox regression models and survival analysis was performed. Results Seventy patients were included. 37.1% required endotracheal intubation, 58.6% suffered medical complications and 24.3% died. Prone positioning was independently associated with lower need for endotracheal intubation (OR 0.05; 95% CI 0.005 to 0.54, p = 0.001). The adjusted HR for death at 28 days in the group of patients requiring endotracheal intubation was 5.4 (95% CI 1.51 to 19.5; p = 0.009). Conclusions The rate of endotracheal intubation in patients with severe respiratory failure from COVID-19 was 37.1%. Complications and mortality were lower in patients in whom endotracheal intubation could be avoided. Prone positioning could reduce the need for endotracheal intubation.
【초록키워드】 COVID-19, Treatment, SARS-CoV-2, Respiratory distress syndrome, Respiratory failure, Mortality, prone, hospital, severe respiratory failure, 28-day mortality, nasal, cohort study, polymerase chain reaction, survival, Prospective, Patient, Effectiveness, death, Complication, complications, severe pneumonia, respiratory, association, Invasive mechanical ventilation, Analysis, High-flow nasal cannula, survival analysis, distress, statistical analysis, COVID-19 patient, prone positioning, Endotracheal intubation, respiratory distress, nasal cannula, Chain Reaction, non-invasive mechanical ventilation, tachypnea, respiratory care unit, failure rate, Cox regression model, Logistic, 95% CI, syndrome, intubation rate, unit, positive, intermediate, Cox regression models, objective, polymerase chain, Result, develop, died, required, was performed, adjusted, suffered, reduce, were recorded, 【제목키워드】 COVID-19 pandemic, Respiratory care,