{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:53:44Z","timestamp":1760147624945,"version":"build-2065373602"},"reference-count":42,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T00:00:00Z","timestamp":1676505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health-Current Research IRCCS","award":["CR 2022\u2013260-04"],"award-info":[{"award-number":["CR 2022\u2013260-04"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: In COVID-19 patients non-invasive-positive-pressure-ventilation (NIPPV) has held a challenging role to reduce mortality and the need for invasive mechanical ventilation (IMV). The aim of this study was to compare the characteristics of patients admitted to a Medical Intermediate Care Unit for acute respiratory failure due to SARS-CoV-2 pneumonia throughout four pandemic waves. Methods: The clinical data of 300 COVID-19 patients treated with continuous positive airway pressure (CPAP) were retrospectively analysed, from March-2020 to April-2022. Results: Non-survivors were older and more comorbid, whereas patients transferred to ICU were younger and had fewer pathologies. Patients were older (from 65 (29\u201391) years in I wave to 77 (32\u201394) in IV, p &lt; 0.001) and with more comorbidities (from Charlson\u2019s Comorbidity Index = 3 (0\u201312) in I to 6 (1\u201312) in IV, p &lt; 0.001). No statistical difference was found for in-hospital mortality (33.0%, 35.8%, 29.6% and 45.9% in I, II, III and IV, p = 0.216), although ICU-transfers rate decreased from 22.0% to 1.4%. Conclusions: COVID-19 patients have become progressively older and with more comorbidities even in critical care area; from risk class analyses by age and comorbidity burden, in-hospital mortality rates remain high and are thus consistent over four waves while ICU-transfers have significantly reduced. Epidemiological changes need to be considered to improve the appropriateness of care.<\/jats:p>","DOI":"10.3390\/jcm12041562","type":"journal-article","created":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T02:52:56Z","timestamp":1676515976000},"page":"1562","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical Characteristics and Outcomes of Patients with Acute Respiratory Failure Due to SARS-CoV-2 Interstitial Pneumonia Treated with CPAP in a Medical Intermediate Care Setting: A Retrospective Observational Study on Comparison of Four Waves"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3060-4203","authenticated-orcid":false,"given":"Silvia","family":"Accordino","sequence":"first","affiliation":[{"name":"High Care Internal Medicine Unit, Internal Medicine Department, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8925-2164","authenticated-orcid":false,"given":"Ciro","family":"Canetta","sequence":"additional","affiliation":[{"name":"High Care Internal Medicine Unit, Internal Medicine Department, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Greta","family":"Bettini","sequence":"additional","affiliation":[{"name":"High Care Internal Medicine Unit, Internal Medicine Department, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Corsico","sequence":"additional","affiliation":[{"name":"High Care Internal Medicine Unit, Internal Medicine Department, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriele","family":"Ghigliazza","sequence":"additional","affiliation":[{"name":"High Care Internal Medicine Unit, Internal Medicine Department, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Barbetta","sequence":"additional","affiliation":[{"name":"High Care Internal Medicine Unit, Internal Medicine Department, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Folli","sequence":"additional","affiliation":[{"name":"High Care Internal Medicine Unit, Internal Medicine Department, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valeria","family":"Savojardo","sequence":"additional","affiliation":[{"name":"High Care Internal Medicine Unit, Internal Medicine Department, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2285-9970","authenticated-orcid":false,"given":"Francesco","family":"Blasi","sequence":"additional","affiliation":[{"name":"Pulmonology and Cystic Fibrosis Unit, Internal Medicine Department, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy"},{"name":"Department of Pathophysiology and Transplantation, University of Milan, via Francesco Sforza 35, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,16]]},"reference":[{"key":"ref_1","unstructured":"(2023, February 08). Living Guidance for Clinical Management of COVID-19: Living Guidance, 23 November 2021 World Health Organization (WHO), Available online: https:\/\/www.who.int\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40560-021-00593-1","article-title":"Noninvasive respiratory support for COVID-19 patients: When, for whom and how?","volume":"10","author":"Sullivan","year":"2022","journal-title":"J. Intensiv. Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1001\/jama.2022.0028","article-title":"Effect of noninvasive respiratory strategies on Intubation or mortality among patients with acute hypoxemic respiratory failure and COVID-19. The RECOVERY-RS Randomized Clinical Trials","volume":"327","author":"Perkins","year":"2022","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2002130","DOI":"10.1183\/13993003.02130-2020","article-title":"Feasibility and clinical impact of out-of-ICU non-invasive respiratory support in patients with COVID-19 related pneumonia","volume":"56","author":"Franco","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1001\/jama.2021.4682","article-title":"Effect of helmet noninvasive ventilation vs high-flow nasal oxygen on days free of respiratory support in patients with COVID-19 and moderate to severe hypoxemic respiratory failure","volume":"325","author":"Grieco","year":"2021","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2001935","DOI":"10.1183\/13993003.01935-2020","article-title":"Helmet CPAP treatment in patients with COVID-19 pneumonia: A multicentre cohort study","volume":"56","author":"Aliberti","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13054-021-03502-y","article-title":"Helmet CPAP to treat hypoxic pneumonia outside the ICU: An observational study during the COVID-10 outbreak","volume":"25","author":"Coppadoro","year":"2021","journal-title":"Crit. Care"},{"key":"ref_8","first-page":"173","article-title":"Predictors of intubation in COVID-19 patients treated with out-of-ICU continuous positive airway pressure","volume":"28","author":"Scotti","year":"2021","journal-title":"Pulmonology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e000692","DOI":"10.1136\/bmjresp-2020-000692","article-title":"CPAP management of COVID-19 respiratory failure: A firs quantitative analysis from an inpatient service evaluation","volume":"7","author":"Ashish","year":"2020","journal-title":"BMJ Open Respir. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1186\/s13054-021-03540-6","article-title":"Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: A systematic review and meta-analysis of non-randomized cohort studies","volume":"25","author":"Papoutsi","year":"2021","journal-title":"Crit. Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1910191","DOI":"10.1080\/20018525.2021.1910191","article-title":"COVID-19 and acute respiratory failure treated with CPAP","volume":"8","author":"Kofod","year":"2021","journal-title":"Eur. Clin. Respir. J."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Pini, S., Radovanovic, D., Saad, M., Gatti, M., Danzo, F., Mondoni, M., Aliberti, S., Centanni, S., Blasi, F., and Chiumello, D.A. (2022). Acute improvements of oxygenation with CPAP and clinical outcomes in severe COVID-19 pneumonia: A multicenter retrospective study. J. Clin. Med., 11.","DOI":"10.3390\/jcm11237186"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1007\/s00134-021-06388-0","article-title":"Evolving changes in mortality of 13.301 critically ill adult patients with COVID-19 over 8 months","volume":"47","author":"Kurtz","year":"2021","journal-title":"Intensiv. Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2219","DOI":"10.1007\/s11739-022-03052-3","article-title":"Comparison between the first and second COVID-19 waves in Internal Medicine Wards in Milan, Italy: A retrospective observational study","volume":"17","author":"Blanca","year":"2022","journal-title":"Intern. Emerg. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1513\/AnnalsATS.202008-1080OC","article-title":"Noninvasive ventilatory support of patients with COVID-19 outside the intensive care units (WARd-COVID)","volume":"18","author":"Bellani","year":"2021","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1001\/jama.2020.6775","article-title":"Presenting Characteristics, Comorbidities, and Outcomes among 5700 Patients Hospitalized with COVID-19 in the New York City Area","volume":"323","author":"Richardson","year":"2020","journal-title":"JAMA"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1001\/jama.2020.1585","article-title":"Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China","volume":"323","author":"Wang","year":"2020","journal-title":"JAMA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1001\/jamainternmed.2020.3539","article-title":"COVID-19 Lombardy ICU Network. Risk Factors Associated with Mortality among Patients with COVID-19 in Intensive Care Units in Lombardy, Italy","volume":"180","author":"Grasselli","year":"2020","journal-title":"JAMA Intern. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"669209","DOI":"10.3389\/fpubh.2021.669209","article-title":"Excess Mortality in Italy during the COVID-19 Pandemic: Assessing the Differences between the First and the Second Wave, Year 2020","volume":"9","author":"Dorrucci","year":"2021","journal-title":"Front. Public Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e216556","DOI":"10.1001\/jamanetworkopen.2021.6556","article-title":"Mortality Among US Patients Hospitalized with SARS-CoV-2 Infection in 2020","volume":"4","author":"Finelli","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"100104","DOI":"10.1016\/j.lanepe.2021.100104","article-title":"Changes in COVID-19 in-hospital mortality in hospitalised adults in England over the first seven months of the pandemic: An observational study using administrative data","volume":"5","author":"Gray","year":"2021","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/S2213-2600(21)00175-2","article-title":"ISARIC4C Investigators. Changes in in-hospital mortality in the first wave of COVID-19: A multicentre prospective observational cohort study using the WHO Clinical Characterisation Protocol UK","volume":"9","author":"Docherty","year":"2021","journal-title":"Lancet Respir. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Iftimie, S., L\u00f3pez-Azcona, A.F., Vallverd\u00fa, I., Hern\u00e1ndez-Flix, S., de Febrer, G., Parra, S., Hern\u00e1ndez-Aguilera, A., Riu, F., Joven, J., and Andreychuk, N. (2021). First and second waves of coronavirus disease-19: A comparative study in hospitalized patients in Reus, Spain. PLoS ONE, 16.","DOI":"10.1101\/2020.12.10.20246959"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Giacomelli, A., Ridolfo, A.L., Pezzati, L., Oreni, L., Carrozzo, G., Beltrami, M., Poloni, A., Caloni, B., Lazzarin, S., and Colombo, M. (2022). Mortality rates among COVID-19 patients hospitalized during the first three waves of the epidemic in Milan, Italy: A prospective observational study. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0263548"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Caramello, V., Catalano, A., Macciotta, A., Dansero, L., Sacerdote, C., Costa, G., Apr\u00e0, F., Tua, A., Boccuzzi, A., and Ricceri, F. (2022). Improvements throughout the three waves of COVID-19 pandemic: Results from 4 million inhabitants of north-west Italy. J. Clin. Med., 11.","DOI":"10.3390\/jcm11154304"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"E400","DOI":"10.9778\/cmajo.20210323","article-title":"The impact of shifting demographics, variants of concern and vaccination on outcomes during the first 3 COVID-19 waves in Alberta and Ontario: A retrospective cohort study","volume":"10","author":"McAlister","year":"2022","journal-title":"CMAJ Open"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e007076","DOI":"10.1136\/bmjgh-2021-007076","article-title":"Epidemiological comparison of the first and second waves of the COVID-19 pandemic in Nigeria, February 2020\u2013April 2021","volume":"6","author":"Akande","year":"2021","journal-title":"BMJ Glob. Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1001\/jama.2021.24868","article-title":"Characteristics and outcomes of hospitalized patients in South Africa during the COVID-19 Omicron wave compared with previous waves","volume":"327","author":"Maslo","year":"2022","journal-title":"JAMA"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1080\/17476348.2021.1960824","article-title":"COVID-19 clinical phenotypes and short-term outcomes: Differences between the first and the second wave of pandemic in Italy","volume":"15","author":"Portacci","year":"2021","journal-title":"Expert Rev. Respir. Med."},{"key":"ref_30","first-page":"158","article-title":"Epidemiology of 4363 deaths associated with COVID-19 during three pandemic waves in a Latin American city with a high mortality rate, 2020\u20132021","volume":"27","author":"Triana","year":"2021","journal-title":"Trop. Med. Int. Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"619","DOI":"10.4103\/ijmr.ijmr_1628_21","article-title":"Clinical profile of hospitalized COVID-19 patients in first & second wave of the pandemic: Insights from an Indian registry based observational study","volume":"153","author":"Mukherjee","year":"2021","journal-title":"Indian J. Med. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e061610","DOI":"10.1136\/bmjopen-2022-061610","article-title":"Comparison of demographic, clinical and laboratory characteristics between first and second COVID-19 waves in a secondary care hospital in Qatar: A retrospective study","volume":"12","author":"Naushad","year":"2022","journal-title":"BMJ Open"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1007\/s43678-022-00275-3","article-title":"Treatments, resource utilization, and outcomes of COVID-19 patients presenting to emergency departments across pandemic waves: An observational study by the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN)","volume":"24","author":"Hohl","year":"2022","journal-title":"Can. J. Emerg. Med."},{"key":"ref_34","first-page":"2","article-title":"Three waves of COVID-19 in a Norwegian local hospital. Tidsskrift for Den norske legeforening 13 January 2022","volume":"141","author":"Myrstad","year":"2022","journal-title":"Tidsskr. Den Nor. Legeforening"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e389","DOI":"10.1093\/cid\/ciac119","article-title":"Comparing Covid-19 pandemic waves in hospitalized patients\u2014A retrospective multicenter, cohort study","volume":"75","author":"Niv","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.thromres.2020.12.019","article-title":"Incidence of thrombotic complications and overall survival in hospitalized patients with COVID-19 in the second and first wave","volume":"199","author":"Kaptein","year":"2021","journal-title":"Thromb. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s13054-020-03449-6","article-title":"Comparison between first and second wave among critically ill COVID-19 patients admitted to a French ICU: No prognostic improvement during the second wave?","volume":"25","author":"Contou","year":"2021","journal-title":"Crit. Care"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e47","DOI":"10.1016\/S2213-2600(21)00101-6","article-title":"Major differences in ICU admissions during the first and second COVID-19 wave in Germany","volume":"9","author":"Karagiannidis","year":"2021","journal-title":"Lancet Respir. Med."},{"key":"ref_39","first-page":"326","article-title":"Comparison of the first and second waves of hospitalized patients with SARS-CoV-2","volume":"118","author":"Budweiser","year":"2021","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"100243","DOI":"10.1016\/j.lanepe.2021.100243","article-title":"Mortality comparison between the first and second\/third waves among 3,795 critical COVID-19 patients with pneumonia admitted to the ICU: A multicentre retrospective cohort study","volume":"11","author":"Carbonell","year":"2021","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1007\/s40520-021-02070-z","article-title":"Frailty as a predictor of mortality in COVID-19 patients receiving CPAP for respiratory insufficiency","volume":"34","author":"Damanti","year":"2022","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"340","DOI":"10.14336\/AD.2022.0127","article-title":"Mechanical ventilation in COVID-19 patients: Insights into the role of age and frailty from a multicentre observational study","volume":"13","author":"Ecarnot","year":"2022","journal-title":"Aging Dis."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/4\/1562\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:37:32Z","timestamp":1760121452000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/4\/1562"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,16]]},"references-count":42,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["jcm12041562"],"URL":"https:\/\/doi.org\/10.3390\/jcm12041562","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2023,2,16]]}}}