Source: World Health Organization, June 2020, adapted.
In this sense, data from China and Italy suggest that patients with hypoxemic COVID-19 respond well to PEEP, indicating a crucial role of NIV as a therapeutic and palliative measure to prevent intubation. Statistics from retrospective analyzes in China indicate that up to 30% of admitted patients required NIV, 84 while the first reports from Italy indicate values ​​close to 31%. Given current epidemiological trends, these requirements are likely to exceed the current capacity of most hospitals, if not all, if aggressive preparatory measures are not taken [23].
In this effort, it is important to characterize patients with COVID-19 who need treatment in an ICU. In this context, a retrospective study was carried out with 1,591 consecutive patients with COVID-19 confirmed in the laboratory and referred for admission to the ICU at the center of the Fondazione IRCCS coordinator Ca ’Granda Ospedale Maggiore Policlinico, Milan, Italy, of the 72 hospitals in this network among February 20 and March 18, 2020. The date of the final follow-up was March 25, 2020. Therefore, in this series of cases of critically ill patients with laboratory-confirmed COVID-19, admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26% [24].
Another study looked at the relationship between obesity and SARS by SARS-CoV-2. In this retrospective cohort study, the relationship between clinical characteristics, including body mass index (BMI) and the need for invasive mechanical ventilation (IMV) in 124 consecutive patients admitted to intensive care by SARS-CoV-2, was analyzed, in a single French center. Obesity (BMI> 30 kg/m2) and severe obesity (BMI> 35 kg/m2) were present in 47.6% and 28.2% of cases, respectively. Overall, 85 patients (68.6%) required IMV. The proportion of patients who needed IMV increased with the BMI categories (p <0.01, chi-square test for trend), and was higher in patients with a BMI> 35 kg/m2 (85.7%). In multivariate logistic regression, the need for IMV was significantly associated with male gender (p <0.05) and BMI (p <0.05), regardless of age, diabetes, and hypertension. The proportion ratio for IMV in patients with a BMI> 35 kg/m2 versus patients with a BMI <25 kg/m2 was 7.36. Therefore, there was a high frequency of obesity among patients admitted to intensive care with COVID-19. The severity of the disease worsened as the BMI increased. Thus, obesity is a risk factor for the severity of SARS-CoV-2, requiring greater attention to preventive measures in susceptible individuals [25].
Based on current data from China and Italy, it is recommended to expand the storage of NIV devices and ventilators in hospitals in general. To combat hospital spread and aerosolization of the SARS-CoV-2 virus, priority was given to double-limbed NIV devices with expiratory filters, such as the PB840 ventilator Viral filter proximal to the leak port on single-limb devices, single-member NIV devices use CPAP with viral filters before PEEP valves. It is strongly recommended to provide part of the emergency and inpatient units for patients with COVID-19, with patient bays and rooms equipped to administer NIV [26].