COVID-19 multidisciplinary high dependency unit: the Milan model
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REVIEW
Open Access
COVID-19 multidisciplinary high dependency unit: the Milan model Stefano Aliberti1,2*, Francesco Amati1,2, Maria Pappalettera1,2, Marta Di Pasquale1,2, Alice D’Adda1,2, Marco Mantero1,2, Andrea Gramegna1,2, Edoardo Simonetta1,2, Anna Maria Oneta1,2, Emilia Privitera1,2, Andrea Gori2,3, Giorgio Bozzi2,3, Flora Peyvandi2,4, Francesca Minoia5, Giovanni Filocamo5, Chiara Abbruzzese2,6, Marco Vicenzi2,7,8, Paola Tagliabue2,6, Salvatore Alongi2,6 and Francesco Blasi1,2
Abstract COVID-19 is a complex and heterogeneous disease. The pathogenesis and the complications of the disease are not fully elucidated, and increasing evidence shows that SARS-CoV-2 causes a systemic inflammatory disease rather than a pulmonary disease. The management of hospitalized patients in COVID-19 dedicated units is advisable for segregation purpose as well as for infection control. In this article we present the standard operating procedures of our COVID-19 high dependency unit of the Policlinico Hospital, in Milan. Our high dependency unit is based on a multidisciplinary approach. We think that the multidisciplinary involvement of several figures can better identify treatable traits of COVID-19 disease, early identify patients who can quickly deteriorate, particularly patients with multiple comorbidities, and better manage complications related to off-label treatments. Although no generalizable to other hospitals and different healthcare settings, we think that our experience and our point of view can be helpful for countries and hospitals that are now starting to face the COVID-19 outbreak. Keywords: COVID-19, High dependency unit, Multidisciplinary approach, Management
Background On January 30, 2020, the World Health Organization (WHO) designated an outbreak of a novel coronavirus not seen before in humans to be a “public health emergency of international concern” [1]. On March 11, 2020, WHO declared the coronavirus disease 2019 (COVID19) outbreak a global pandemic [2, 3]. In March 2020, Italy became the epicenter for COVID-19 in Europe, and the second most affected country after China worldwide [4]. Up to 20% of suspected and confirmed patients with Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection develop severe hypoxemia and * Correspondence: [email protected] 1 IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122 Milan, Italy 2 University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy Full list of author information is available at the end of the article
require some forms of ventilatory support, such as highflow nasal cannula (HFNC), non-invasive (NIV) or invasive mechanical ventilation (IMV). Furthermore, other important challenges have been identified soon after the disease development, including cardiac, renal, neurological and thromboembolic complications [5–9]. A rapid widespread of units dedicated to COVID-19 patients has characterized the public health scenario world
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