Introduction The COVID-19 pandemic required careful management of intensive care unit (ICU) admissions, to reduce ICU overload while facing limitations in resources. We implemented a standardized, physiology-based, ICU admission criteria and analyzed the mortality rate of patients refused from the ICU. Materials and methods In this retrospective observational study, COVID-19 patients proposed for ICU admission were consecutively analyzed; Do-Not-Resuscitate patients were excluded. Patients presenting an oxygen peripheral saturation (SpO 2 ) lower than 85% and/or dyspnea and/or mental confusion resulted eligible for ICU admission; patients not presenting these criteria remained in the ward with an intensive monitoring protocol. Primary outcome was both groups’ survival rate. Secondary outcome was a sub analysis correlating SpO 2 cutoff with ICU admission. Results From March 2020 to January 2021, 1623 patients were admitted to our Center; 208 DNR patients were excluded; 97 patients were evaluated. The ICU-admitted group (n = 63) mortality rate resulted 15.9% at 28 days and 27% at 40 days; the ICU-refused group (n = 34) mortality rate resulted 0% at both intervals (p < 0.001). With a SpO 2 cut-off of 85%, a significant correlation was found (p = 0.009), but with a 92% a cut-off there was no correlation with ICU admission (p = 0.26). A similar correlation was also found with dyspnea (p = 0.0002). Conclusion In COVID-19 patients, standardized ICU admission criteria appeared to safely reduce ICU overload. In the absence of dyspnea and/or confusion, a SpO 2 cutoff up to 85% for ICU admission was not burdened by negative outcomes. In a pandemic context, the SpO 2 cutoff of 92%, as a threshold for ICU admission, needs critical re-evaluation.
【초록키워드】 pandemic, protocol, intensive care, COVID-19 pandemic, oxygen, outcome, ICU, outcomes, management, Dyspnea, Patient, ICU admission, survival rate, mortality rate, correlation, threshold, Intensive, Critical, COVID-19 patients, retrospective, Analysis, COVID-19 patient, criteria, Confusion, Admissions, Cutoff, limitation, no correlation, material, cut-off, resources, Mental, secondary, Result, analyzed, remained, evaluated, required, absence, reduce, presenting, interval, DNR, eligible, were excluded, 【제목키워드】 COVID-19, Critically ill, criteria, approach,