Use of critical care resources during the first 2 weeks (February 24–March 8, 2020) of the Covid-19 outbreak in Italy

Tommaso Tonetti; Giacomo Grasselli; Alberto Zanella; Giacinto Pizzilli; Roberto Fumagalli; Simone Piva; Luca Lorini; Giorgio Iotti; Giuseppe Foti; Sergio Colombo; Luigi Vivona; Sandra Rossi; Massimo Girardis; Vanni Agnoletti; Anselmo Campagna; Giovanni Gordini; Paolo Navalesi; Annalisa Boscolo; Alessandro Graziano; Ilaria Valeri; Andrea Vianello; Danilo Cereda; Claudia Filippini; Maurizio Cecconi; Franco Locatelli; Michele Bartoletti; Maddalena Giannella; Pierluigi Viale; Massimo Antonelli; Stefano Nava; Antonio Pesenti; V. Marco Ranieri; Giovanni Albano; Armando Alborghetti; Giorgio Aldegheri; Benvenuto Antonini; Nicolangela Belgiorno; Giacomo Bellani; Enrico Beretta; Stefano Bonazzi; Massimo Borelli; Luca Cabrini; Livio Carnevale; Sergio Carnevale; Gianpaolo Castelli; Emanuele Catena; Davide Chiumello; Antonio Coluccello; Davide Coppini; Daniel Covello; Gianluca De Filippi; Marco Dei Poli; Paolo Dughi; Giorgio Gallioli; Paolo Gnesin; Stefano Greco; Luca Guatteri; Davide Guzzon; Roberto Keim; Giovanni Landoni; Thomas Langer; Andrea Lombardo; Giovanni Marino; Guido Merli; Dario Merlo; Francesco Mojoli; Stefano Muttini; Giuseppe Natalini; Nicola Petrucci; Angelo Pezzi; Danilo Radrizzani; Maurizio Raimondi; Mario Riccio; Enrico Storti; Mario Tavola; Giovanni Vitale; Enrico Bosco; Mauro Antonio Calò; Vinicio Danzi; Silvia De Rosa; Antonio Farnia; Francesco Lazzari; Marco Meggiolaro; Marina Munari; Mario Saia; Nicolò Sella; Eugenio Serra; Ivo Tiberio; Massimo Baiocchi; Maria Benedetto; Martina Bordini; Fabio Caramelli; Nicola Cilloni; Maria Della Giovampaola; Andrea Fanelli; Guido Frascaroli; Maurizio Fusari; Giovanni Gordini; Stefano Maitan; Costanza Martino; Rita Maria Melotti; Raffaele Merola; Francesco Minardi; Federico Moro; Giuseppe Nardi; Massimo Nolli; Elisabetta Pierucci; Antonella Potalivo; Francesca Repetti; Pierpaolo Salsi; Marina Terzitta; Martina Tosi; Sergio Venturi; Carlo Alberto Volta; Gianluca Zani; Andrea Zanoni

doi:10.1186/s13613-020-00750-z

Use of critical care resources during the first 2 weeks (February 24–March 8, 2020) of the Covid-19 outbreak in Italy

Tommaso Tonetti, Giacomo Grasselli, Alberto Zanella, Giacinto Pizzilli, Roberto Fumagalli, Simone Piva, Luca Lorini, Giorgio Iotti, Giuseppe Foti, Sergio Colombo, Luigi Vivona, Sandra Rossi, Massimo Girardis, Vanni Agnoletti, Anselmo Campagna, Giovanni Gordini, Paolo Navalesi, Annalisa Boscolo, Alessandro Graziano, Ilaria ValeriAndrea Vianello, Danilo Cereda, Claudia Filippini, Maurizio Cecconi, Franco Locatelli, Michele Bartoletti, Maddalena Giannella, Pierluigi Viale, Massimo Antonelli, Stefano Nava, Antonio Pesenti, V. Marco Ranieri, Giovanni Albano, Armando Alborghetti, Giorgio Aldegheri, Benvenuto Antonini, Nicolangela Belgiorno, Giacomo Bellani, Enrico Beretta, Stefano Bonazzi, Massimo Borelli, Luca Cabrini, Livio Carnevale, Sergio Carnevale, Gianpaolo Castelli, Emanuele Catena, Davide Chiumello, Antonio Coluccello, Davide Coppini, Daniel Covello, Gianluca De Filippi, Marco Dei Poli, Paolo Dughi, Giorgio Gallioli, Paolo Gnesin, Stefano Greco, Luca Guatteri, Davide Guzzon, Roberto Keim, Giovanni Landoni, Thomas Langer, Andrea Lombardo, Giovanni Marino, Guido Merli, Dario Merlo, Francesco Mojoli, Stefano Muttini, Giuseppe Natalini, Nicola Petrucci, Angelo Pezzi, Danilo Radrizzani, Maurizio Raimondi, Mario Riccio, Enrico Storti, Mario Tavola, Giovanni Vitale, Enrico Bosco, Mauro Antonio Calò, Vinicio Danzi, Silvia De Rosa, Antonio Farnia, Francesco Lazzari, Marco Meggiolaro, Marina Munari, Mario Saia, Nicolò Sella, Eugenio Serra, Ivo Tiberio, Massimo Baiocchi, Maria Benedetto, Martina Bordini, Fabio Caramelli, Nicola Cilloni, Maria Della Giovampaola, Andrea Fanelli, Guido Frascaroli, Maurizio Fusari, Giovanni Gordini, Stefano Maitan, Costanza Martino, Rita Maria Melotti, Raffaele Merola, Francesco Minardi, Federico Moro, Giuseppe Nardi, Massimo Nolli, Elisabetta Pierucci, Antonella Potalivo, Francesca Repetti, Pierpaolo Salsi, Marina Terzitta, Martina Tosi, Sergio Venturi, Carlo Alberto Volta, Gianluca Zani, Andrea Zanoni

Risultato della ricerca: Contributo in rivista › Articolo in rivista

Abstract

Background: A Covid-19 outbreak developed in Lombardy, Veneto and Emilia-Romagna (Italy) at the end of February 2020. Fear of an imminent saturation of available ICU beds generated the notion that rationing of intensive care resources could have been necessary. Results: In order to evaluate the impact of Covid-19 on the ICU capacity to manage critically ill patients, we performed a retrospective analysis of the first 2 weeks of the outbreak (February 24–March 8). Data were collected from regional registries and from a case report form sent to participating sites. ICU beds increased from 1545 to 1989 (28.7%), and patients receiving respiratory support outside the ICU increased from 4 (0.6%) to 260 (37.0%). Patients receiving respiratory support outside the ICU were significantly older [65 vs. 77 years], had more cerebrovascular (5.8 vs. 13.1%) and renal (5.3 vs. 10.0%) comorbidities and less obesity (31.4 vs. 15.5%) than patients admitted to the ICU. PaO2/FiO2 ratio, respiratory rate and arterial pH were higher [165 vs. 244; 20 vs. 24 breath/min; 7.40 vs. 7.46] and PaCO2 and base excess were lower [34 vs. 42 mmHg; 0.60 vs. 1.30] in patients receiving respiratory support outside the ICU than in patients admitted to the ICU, respectively. Conclusions: Increase in ICU beds and use of out-of-ICU respiratory support allowed effective management of the first 14 days of the Covid-19 outbreak, avoiding resource rationing.

Lingua originale	English
pagine (da-a)	1-8
Numero di pagine	8
Rivista	Annals of Intensive Care
Volume	10
DOI	https://doi.org/10.1186/s13613-020-00750-z
Stato di pubblicazione	Pubblicato - 2020

Keywords

Acute respiratory failure
COVID-19
ICU
Non-invasive ventilation
Rationing

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10.1186/s13613-020-00750-z

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Tonetti, T., Grasselli, G., Zanella, A., Pizzilli, G., Fumagalli, R., Piva, S., Lorini, L., Iotti, G., Foti, G., Colombo, S., Vivona, L., Rossi, S., Girardis, M., Agnoletti, V., Campagna, A., Gordini, G., Navalesi, P., Boscolo, A., Graziano, A., ... Zanoni, A. (2020). Use of critical care resources during the first 2 weeks (February 24–March 8, 2020) of the Covid-19 outbreak in Italy. Annals of Intensive Care, 10, 1-8. https://doi.org/10.1186/s13613-020-00750-z

@article{ee27f88f3b074006882745ad2160998e,

title = "Use of critical care resources during the first 2 weeks (February 24–March 8, 2020) of the Covid-19 outbreak in Italy",

abstract = "Background: A Covid-19 outbreak developed in Lombardy, Veneto and Emilia-Romagna (Italy) at the end of February 2020. Fear of an imminent saturation of available ICU beds generated the notion that rationing of intensive care resources could have been necessary. Results: In order to evaluate the impact of Covid-19 on the ICU capacity to manage critically ill patients, we performed a retrospective analysis of the first 2 weeks of the outbreak (February 24–March 8). Data were collected from regional registries and from a case report form sent to participating sites. ICU beds increased from 1545 to 1989 (28.7%), and patients receiving respiratory support outside the ICU increased from 4 (0.6%) to 260 (37.0%). Patients receiving respiratory support outside the ICU were significantly older [65 vs. 77 years], had more cerebrovascular (5.8 vs. 13.1%) and renal (5.3 vs. 10.0%) comorbidities and less obesity (31.4 vs. 15.5%) than patients admitted to the ICU. PaO2/FiO2 ratio, respiratory rate and arterial pH were higher [165 vs. 244; 20 vs. 24 breath/min; 7.40 vs. 7.46] and PaCO2 and base excess were lower [34 vs. 42 mmHg; 0.60 vs. 1.30] in patients receiving respiratory support outside the ICU than in patients admitted to the ICU, respectively. Conclusions: Increase in ICU beds and use of out-of-ICU respiratory support allowed effective management of the first 14 days of the Covid-19 outbreak, avoiding resource rationing.",

keywords = "Acute respiratory failure, COVID-19, ICU, Non-invasive ventilation, Rationing, Acute respiratory failure, COVID-19, ICU, Non-invasive ventilation, Rationing",

author = "Tommaso Tonetti and Giacomo Grasselli and Alberto Zanella and Giacinto Pizzilli and Roberto Fumagalli and Simone Piva and Luca Lorini and Giorgio Iotti and Giuseppe Foti and Sergio Colombo and Luigi Vivona and Sandra Rossi and Massimo Girardis and Vanni Agnoletti and Anselmo Campagna and Giovanni Gordini and Paolo Navalesi and Annalisa Boscolo and Alessandro Graziano and Ilaria Valeri and Andrea Vianello and Danilo Cereda and Claudia Filippini and Maurizio Cecconi and Franco Locatelli and Michele Bartoletti and Maddalena Giannella and Pierluigi Viale and Massimo Antonelli and Stefano Nava and Antonio Pesenti and Ranieri, {V. Marco} and Giovanni Albano and Armando Alborghetti and Giorgio Aldegheri and Benvenuto Antonini and Nicolangela Belgiorno and Giacomo Bellani and Enrico Beretta and Stefano Bonazzi and Massimo Borelli and Luca Cabrini and Livio Carnevale and Sergio Carnevale and Gianpaolo Castelli and Emanuele Catena and Davide Chiumello and Antonio Coluccello and Davide Coppini and Daniel Covello and Gianluca De Filippi and Marco Dei Poli and Paolo Dughi and Giorgio Gallioli and Paolo Gnesin and Stefano Greco and Luca Guatteri and Davide Guzzon and Roberto Keim and Giovanni Landoni and Thomas Langer and Andrea Lombardo and Giovanni Marino and Guido Merli and Dario Merlo and Francesco Mojoli and Stefano Muttini and Giuseppe Natalini and Nicola Petrucci and Angelo Pezzi and Danilo Radrizzani and Maurizio Raimondi and Mario Riccio and Enrico Storti and Mario Tavola and Giovanni Vitale and Enrico Bosco and Cal{\`o}, {Mauro Antonio} and Vinicio Danzi and Silvia De Rosa and Antonio Farnia and Francesco Lazzari and Marco Meggiolaro and Marina Munari and Mario Saia and Nicol{\`o} Sella and Eugenio Serra and Ivo Tiberio and Massimo Baiocchi and Maria Benedetto and Martina Bordini and Fabio Caramelli and Nicola Cilloni and Maria Della Giovampaola and Andrea Fanelli and Guido Frascaroli and Maurizio Fusari and Giovanni Gordini and Stefano Maitan and Costanza Martino and Melotti, {Rita Maria} and Raffaele Merola and Francesco Minardi and Federico Moro and Giuseppe Nardi and Massimo Nolli and Elisabetta Pierucci and Antonella Potalivo and Francesca Repetti and Pierpaolo Salsi and Marina Terzitta and Martina Tosi and Sergio Venturi and Volta, {Carlo Alberto} and Gianluca Zani and Andrea Zanoni",

year = "2020",

doi = "10.1186/s13613-020-00750-z",

language = "English",

volume = "10",

pages = "1--8",

journal = "Annals of Intensive Care",

issn = "2110-5820",

publisher = "Springer-Verlag GmbH and Co. KG",

}

Tonetti, T, Grasselli, G, Zanella, A, Pizzilli, G, Fumagalli, R, Piva, S, Lorini, L, Iotti, G, Foti, G, Colombo, S, Vivona, L, Rossi, S, Girardis, M, Agnoletti, V, Campagna, A, Gordini, G, Navalesi, P, Boscolo, A, Graziano, A, Valeri, I, Vianello, A, Cereda, D, Filippini, C, Cecconi, M, Locatelli, F, Bartoletti, M, Giannella, M, Viale, P, Antonelli, M, Nava, S, Pesenti, A, Ranieri, VM, Albano, G, Alborghetti, A, Aldegheri, G, Antonini, B, Belgiorno, N, Bellani, G, Beretta, E, Bonazzi, S, Borelli, M, Cabrini, L, Carnevale, L, Carnevale, S, Castelli, G, Catena, E, Chiumello, D, Coluccello, A, Coppini, D, Covello, D, De Filippi, G, Dei Poli, M, Dughi, P, Gallioli, G, Gnesin, P, Greco, S, Guatteri, L, Guzzon, D, Keim, R, Landoni, G, Langer, T, Lombardo, A, Marino, G, Merli, G, Merlo, D, Mojoli, F, Muttini, S, Natalini, G, Petrucci, N, Pezzi, A, Radrizzani, D, Raimondi, M, Riccio, M, Storti, E, Tavola, M, Vitale, G, Bosco, E, Calò, MA, Danzi, V, De Rosa, S, Farnia, A, Lazzari, F, Meggiolaro, M, Munari, M, Saia, M, Sella, N, Serra, E, Tiberio, I, Baiocchi, M, Benedetto, M, Bordini, M, Caramelli, F, Cilloni, N, Della Giovampaola, M, Fanelli, A, Frascaroli, G, Fusari, M, Gordini, G, Maitan, S, Martino, C, Melotti, RM, Merola, R, Minardi, F, Moro, F, Nardi, G, Nolli, M, Pierucci, E, Potalivo, A, Repetti, F, Salsi, P, Terzitta, M, Tosi, M, Venturi, S, Volta, CA, Zani, G & Zanoni, A 2020, 'Use of critical care resources during the first 2 weeks (February 24–March 8, 2020) of the Covid-19 outbreak in Italy', Annals of Intensive Care, vol. 10, pagg. 1-8. https://doi.org/10.1186/s13613-020-00750-z

TY - JOUR

T1 - Use of critical care resources during the first 2 weeks (February 24–March 8, 2020) of the Covid-19 outbreak in Italy

AU - Tonetti, Tommaso

AU - Grasselli, Giacomo

AU - Zanella, Alberto

AU - Pizzilli, Giacinto

AU - Fumagalli, Roberto

AU - Piva, Simone

AU - Lorini, Luca

AU - Iotti, Giorgio

AU - Foti, Giuseppe

AU - Colombo, Sergio

AU - Vivona, Luigi

AU - Rossi, Sandra

AU - Girardis, Massimo

AU - Agnoletti, Vanni

AU - Campagna, Anselmo

AU - Gordini, Giovanni

AU - Navalesi, Paolo

AU - Boscolo, Annalisa

AU - Graziano, Alessandro

AU - Valeri, Ilaria

AU - Vianello, Andrea

AU - Cereda, Danilo

AU - Filippini, Claudia

AU - Cecconi, Maurizio

AU - Locatelli, Franco

AU - Bartoletti, Michele

AU - Giannella, Maddalena

AU - Viale, Pierluigi

AU - Antonelli, Massimo

AU - Nava, Stefano

AU - Pesenti, Antonio

AU - Ranieri, V. Marco

AU - Albano, Giovanni

AU - Alborghetti, Armando

AU - Aldegheri, Giorgio

AU - Antonini, Benvenuto

AU - Belgiorno, Nicolangela

AU - Bellani, Giacomo

AU - Beretta, Enrico

AU - Bonazzi, Stefano

AU - Borelli, Massimo

AU - Cabrini, Luca

AU - Carnevale, Livio

AU - Carnevale, Sergio

AU - Castelli, Gianpaolo

AU - Catena, Emanuele

AU - Chiumello, Davide

AU - Coluccello, Antonio

AU - Coppini, Davide

AU - Covello, Daniel

AU - De Filippi, Gianluca

AU - Dei Poli, Marco

AU - Dughi, Paolo

AU - Gallioli, Giorgio

AU - Gnesin, Paolo

AU - Greco, Stefano

AU - Guatteri, Luca

AU - Guzzon, Davide

AU - Keim, Roberto

AU - Landoni, Giovanni

AU - Langer, Thomas

AU - Lombardo, Andrea

AU - Marino, Giovanni

AU - Merli, Guido

AU - Merlo, Dario

AU - Mojoli, Francesco

AU - Muttini, Stefano

AU - Natalini, Giuseppe

AU - Petrucci, Nicola

AU - Pezzi, Angelo

AU - Radrizzani, Danilo

AU - Raimondi, Maurizio

AU - Riccio, Mario

AU - Storti, Enrico

AU - Tavola, Mario

AU - Vitale, Giovanni

AU - Bosco, Enrico

AU - Calò, Mauro Antonio

AU - Danzi, Vinicio

AU - De Rosa, Silvia

AU - Farnia, Antonio

AU - Lazzari, Francesco

AU - Meggiolaro, Marco

AU - Munari, Marina

AU - Saia, Mario

AU - Sella, Nicolò

AU - Serra, Eugenio

AU - Tiberio, Ivo

AU - Baiocchi, Massimo

AU - Benedetto, Maria

AU - Bordini, Martina

AU - Caramelli, Fabio

AU - Cilloni, Nicola

AU - Della Giovampaola, Maria

AU - Fanelli, Andrea

AU - Frascaroli, Guido

AU - Fusari, Maurizio

AU - Gordini, Giovanni

AU - Maitan, Stefano

AU - Martino, Costanza

AU - Melotti, Rita Maria

AU - Merola, Raffaele

AU - Minardi, Francesco

AU - Moro, Federico

AU - Nardi, Giuseppe

AU - Nolli, Massimo

AU - Pierucci, Elisabetta

AU - Potalivo, Antonella

AU - Repetti, Francesca

AU - Salsi, Pierpaolo

AU - Terzitta, Marina

AU - Tosi, Martina

AU - Venturi, Sergio

AU - Volta, Carlo Alberto

AU - Zani, Gianluca

AU - Zanoni, Andrea

PY - 2020

Y1 - 2020

N2 - Background: A Covid-19 outbreak developed in Lombardy, Veneto and Emilia-Romagna (Italy) at the end of February 2020. Fear of an imminent saturation of available ICU beds generated the notion that rationing of intensive care resources could have been necessary. Results: In order to evaluate the impact of Covid-19 on the ICU capacity to manage critically ill patients, we performed a retrospective analysis of the first 2 weeks of the outbreak (February 24–March 8). Data were collected from regional registries and from a case report form sent to participating sites. ICU beds increased from 1545 to 1989 (28.7%), and patients receiving respiratory support outside the ICU increased from 4 (0.6%) to 260 (37.0%). Patients receiving respiratory support outside the ICU were significantly older [65 vs. 77 years], had more cerebrovascular (5.8 vs. 13.1%) and renal (5.3 vs. 10.0%) comorbidities and less obesity (31.4 vs. 15.5%) than patients admitted to the ICU. PaO2/FiO2 ratio, respiratory rate and arterial pH were higher [165 vs. 244; 20 vs. 24 breath/min; 7.40 vs. 7.46] and PaCO2 and base excess were lower [34 vs. 42 mmHg; 0.60 vs. 1.30] in patients receiving respiratory support outside the ICU than in patients admitted to the ICU, respectively. Conclusions: Increase in ICU beds and use of out-of-ICU respiratory support allowed effective management of the first 14 days of the Covid-19 outbreak, avoiding resource rationing.

AB - Background: A Covid-19 outbreak developed in Lombardy, Veneto and Emilia-Romagna (Italy) at the end of February 2020. Fear of an imminent saturation of available ICU beds generated the notion that rationing of intensive care resources could have been necessary. Results: In order to evaluate the impact of Covid-19 on the ICU capacity to manage critically ill patients, we performed a retrospective analysis of the first 2 weeks of the outbreak (February 24–March 8). Data were collected from regional registries and from a case report form sent to participating sites. ICU beds increased from 1545 to 1989 (28.7%), and patients receiving respiratory support outside the ICU increased from 4 (0.6%) to 260 (37.0%). Patients receiving respiratory support outside the ICU were significantly older [65 vs. 77 years], had more cerebrovascular (5.8 vs. 13.1%) and renal (5.3 vs. 10.0%) comorbidities and less obesity (31.4 vs. 15.5%) than patients admitted to the ICU. PaO2/FiO2 ratio, respiratory rate and arterial pH were higher [165 vs. 244; 20 vs. 24 breath/min; 7.40 vs. 7.46] and PaCO2 and base excess were lower [34 vs. 42 mmHg; 0.60 vs. 1.30] in patients receiving respiratory support outside the ICU than in patients admitted to the ICU, respectively. Conclusions: Increase in ICU beds and use of out-of-ICU respiratory support allowed effective management of the first 14 days of the Covid-19 outbreak, avoiding resource rationing.

KW - Acute respiratory failure

KW - COVID-19

KW - ICU

KW - Non-invasive ventilation

KW - Rationing

KW - Acute respiratory failure

KW - COVID-19

KW - ICU

KW - Non-invasive ventilation

KW - Rationing

UR - http://hdl.handle.net/10807/230072

U2 - 10.1186/s13613-020-00750-z

DO - 10.1186/s13613-020-00750-z

M3 - Article

SN - 2110-5820

VL - 10

SP - 1

EP - 8

JO - Annals of Intensive Care

JF - Annals of Intensive Care

ER -

Use of critical care resources during the first 2 weeks (February 24–March 8, 2020) of the Covid-19 outbreak in Italy

Abstract

Keywords

OSS delle Nazioni Unite

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