Development of a Critical Care Response - Experiences from Italy during the Covid19 Pandemic.

Rezoagli, Emanuele; Magliocca, Aurora; Bellani, Giacomo; Pesenti, Antonio; Grasselli, Giacomo

Italy was the first western country facing an outbreak of coronavirus disease 2019 (COVID-19). The first Italian patient diagnosed with COVID-19 was admitted, on the 20(th) of February 2020, to the intensive care unit (ICU) in Codogno, (Lodi, Lombardy, Italy) and the number of reported positive cases increased to 36 in the next 24 hours, and then exponentially for 18 days. This triggered a prompt, coordinated response of the ICUs in the epicenter region of the outbreak - COVID19 Lombardy Network - that resulted in a massive surge in the ICU bed capacity. The COVID19 Lombardy Network organized a structured logistic response. Furthermore, it provided a significant amount of scientific evidence to highlight globally useful information on the clinical history of COVID-19 associated respiratory failure. The Italian experience was characterized by a significant use of helmet cPAP and prone positioning in awake patients to cope with the resource limitations during the pandemic outbreak. Specific national recommendations were structured to help clinicians during the hard choices of resource allocation. Humanitarian and educational programs were developed within the Italian population to promote awareness about patients and healthcare providers’ conditions during the pandemic.