Use of critical care resources during the first 2 weeks (February 24–March 8, 2020) of the Covid-19 outbreak in Italy
Authors: Tonetti Tommaso , Grasselli Giacomo , Zanella Alberto , Pizzilli Giacinto , Fumagalli Roberto , Piva Simone , Lorini Luca , Iotti Giorgio , Foti Giuseppe , Colombo Sergio , Vivona Luigi , Rossi Sandra , Girardis Massimo , Agnoletti Vanni , Campagna Anselmo , Gordini Giovanni , Navalesi Paolo , Boscolo Annalisa , Graziano Alessandro , Valeri Ilaria , Vianello Andrea , Cereda Danilo , Filippini Claudia , Cecconi Maurizio , Locatelli Franco , Bartoletti Michele , Giannella Maddalena , Viale Pierluigi , Antonelli Massimo , Nava Stefano , Pesenti Antonio , Ranieri V. Marco ,   the COVID-19 Northern Italian ICU Network, Albano Giovanni , Alborghetti Armando , Aldegheri Giorgio , Antonini Benvenuto , Belgiorno Nicolangela , Bellani Giacomo , Beretta Enrico , Bonazzi Stefano , Borelli Massimo , Cabrini Luca , Carnevale Livio , Carnevale Sergio , Castelli Gianpaolo , Catena Emanuele , Chiumello Davide , Coluccello Antonio , Coppini Davide , Covello Daniel , De Filippi Gianluca , Dei Poli Marco , Dughi Paolo , Gallioli Giorgio , Gnesin Paolo , Greco Stefano , Guatteri Luca , Guzzon Davide , Keim Roberto , Landoni Giovanni , Langer Thomas , Lombardo Andrea , Marino Giovanni , Merli Guido , Merlo Dario , Mojoli Francesco , Muttini Stefano , Natalini Giuseppe , Petrucci Nicola , Pezzi Angelo , Radrizzani Danilo , Raimondi Maurizio , Riccio Mario , Storti Enrico , Tavola Mario , Vitale Giovanni , Bosco Enrico , Calò Mauro Antonio , Danzi Vinicio , De Rosa Silvia , Farnia Antonio , Lazzari Francesco , Meggiolaro Marco , Munari Marina , Saia Mario , Sella Nicolò , Serra Eugenio , Tiberio Ivo , Baiocchi Massimo , Benedetto Maria , Bordini Martina , Caramelli Fabio , Cilloni Nicola , Della Giovampaola Maria , Fanelli Andrea , Frascaroli Guido , Fusari Maurizio , Gordini Giovanni , Maitan Stefano , Martino Costanza , Melotti Rita Maria , Merola Raffaele , Minardi Francesco , Moro Federico , Nardi Giuseppe , Nolli Massimo , Pierucci Elisabetta , Potalivo Antonella , Repetti Francesca , Salsi Pierpaolo , Terzitta Marina , Tosi Martina , Venturi Sergio , Volta Carlo Alberto , Zani Gianluca , Zanoni Andrea 
Published: October 2020

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.