Cost and Mortality Analysis of an Intermediate Respiratory Care Unit. Is It Really Efficient and Safe?

Frades, Sarah Heili; Miguel, María del Pilar Carballosa de; Prieto, Alba Naya; Lozano, Marina Galdeano; García, Xavier Mate; Mahíllo‐Fernández, Ignacio; Ormaechea, Itziar Fernández; Suárez, Laura Álvarez; Blas, Farah Ezzine De; Venegas, María José Checa; Mangado, Nicolás González; Barba, Germán Peces

doi:10.1016/j.arbr.2019.06.008

Cited by 9 publications

(10 citation statements)

References 17 publications

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“…This resulted in a reduction of ICU burden and allowed for more response time to face the rapid increase of severe cases. A previous study by Heili-Frades et al showed that IMCU may avoid approximately 500.000 euros per year of hospital costs, especially in high complexity patients requiring HFNC oxygen therapy or NIV (8). Although the speci c admission costs of COVID-19 patients have not been estimated, the IMCU not only could help to improve ICU bed availability, but also to lower overall healthcare costs.…”

Section: Discussionmentioning

confidence: 99%

“…Intermediate respiratory care units (IMCU) are a useful resource for the management of complex patients that do not require admission to the ICU, invasive mechanical ventilation or invasive monitoring (8). IMCU can function as a space for management escalation and de-escalation between the general ward and the ICU, especially when patient monitoring is needed and/or when respiratory support with HFNC or NIV is required (8)(9)(10). Bene ts of IMCU include reducing ICU admission time and increasing ICU bed capacity, as well as lowering mortality and health care costs (8,10,11).…”

Section: Introductionmentioning

confidence: 99%

“…IMCU can function as a space for management escalation and de-escalation between the general ward and the ICU, especially when patient monitoring is needed and/or when respiratory support with HFNC or NIV is required (8)(9)(10). Bene ts of IMCU include reducing ICU admission time and increasing ICU bed capacity, as well as lowering mortality and health care costs (8,10,11). Although it is well known the importance of ICU, the impact and speci c role of IMCU during the COVID-19 pandemic has not been properly assessed.…”

Section: Introductionmentioning

confidence: 99%

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Impact of an Intermediate Respiratory Care Unit on Clinical Outcomes of COVID-19 Patients

Suárez-Cuartín

Gasa

Bermudo

et al. 2020

Preprint

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Background: Many severe COVID-19 patients require respiratory support and monitoring. An intermediate respiratory care unit (IMCU) may be a valuable element for optimizing patient care and limited health-care resources management. We aim to assess the impact of an IMCU in the management of severe COVID-19.Methods: Observational, retrospective study including patients admitted to the IMCU due to COVID-19 pneumonia during the months of March and April 2020. Patients were stratified based on their requirement of transfer to the intensive care unit (ICU) and on survival status at the end of follow-up. A multivariable Cox proportional hazards method was used to assess risk factors associated with mortality.Results: A total of 253 patients were included. Of them, 68% were male and median age was 65 years (IQR 18 years). Ninety-two patients (36.4%) required ICU transfer. Patients transferred to the ICU had a higher mortality rate (44.6% Vs 24.2%; p<0.001). Multivariable proportional hazards model showed that age ³65 years (HR 4.14; 95%CI 2.31-7.42; p<0.001); chronic respiratory conditions (HR 2.34; 95%CI 1.38-3.99; p=0.002) and chronic kidney disease (HR 2.96; 95%CI 1.61-5.43; p<0.001) were independently associated with mortality. High-dose systemic corticosteroids followed by progressive dose tapering showed a lower risk of death (HR 0.15; 95%CI 0.06-0.40; p<0.001). Conclusions: IMCU allow to safely and effectively manage severe COVID-19 patients requiring respiratory support and non-invasive monitoring, therefore reducing ICU burden. Older age and chronic respiratory or renal conditions are associated with worse clinical outcomes, while treatment with systemic corticosteroids may have a protective effect on mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of an Intermediate Respiratory Care Unit on Clinical Outcomes of COVID-19 Patients

Suárez-Cuartín

Gasa

Bermudo

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Intermediate respiratory care units (IMCU) are a useful resource for the management of complex patients that do not require admission to the ICU, invasive mechanical ventilation or invasive monitoring (8). IMCU can function as a space for management escalation and de-escalation between the general ward and the ICU, especially when patient monitoring is needed and/or when respiratory support with HFNC or NIV is required (8)(9)(10). Benefits of IMCU include reducing ICU admission time and increasing ICU bed capacity, as well as lowering mortality and health care costs (8,10,11).…”

Section: Introductionmentioning

confidence: 99%

“…IMCU can function as a space for management escalation and de-escalation between the general ward and the ICU, especially when patient monitoring is needed and/or when respiratory support with HFNC or NIV is required (8)(9)(10). Benefits of IMCU include reducing ICU admission time and increasing ICU bed capacity, as well as lowering mortality and health care costs (8,10,11). Although the role of the ICU is well-known, there is scarce data regarding the outcomes of severe COVID-19 patients managed in an IMCU during the pandemic.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Severe COVID-19 Patients Admitted to an Intermediate Respiratory Care Unit

et al. 2021

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Introduction: Many severe COVID-19 patients require respiratory support and monitoring. An intermediate respiratory care unit (IMCU) may be a valuable element for optimizing patient care and limited health-care resources management. We aim to assess the clinical outcomes of severe COVID-19 patients admitted to an IMCU.Methods: Observational, retrospective study including patients admitted to the IMCU due to COVID-19 pneumonia during the months of March and April 2020. Patients were stratified based on their requirement of transfer to the intensive care unit (ICU) and on survival status at the end of follow-up. A multivariable Cox proportional hazards method was used to assess risk factors associated with mortality.Results: A total of 253 patients were included. Of them, 68% were male and median age was 65 years (IQR 18 years). Ninety-two patients (36.4%) required ICU transfer. Patients transferred to the ICU had a higher mortality rate (44.6 vs. 24.2%; p < 0.001). Multivariable proportional hazards model showed that age ≥65 years (HR 4.14; 95%CI 2.31–7.42; p < 0.001); chronic respiratory conditions (HR 2.34; 95%CI 1.38–3.99; p = 0.002) and chronic kidney disease (HR 2.96; 95%CI 1.61–5.43; p < 0.001) were independently associated with mortality. High-dose systemic corticosteroids followed by progressive dose tapering showed a lower risk of death (HR 0.15; 95%CI 0.06–0.40; p < 0.001).Conclusions: IMCU may be a useful tool for the multidisciplinary management of severe COVID-19 patients requiring respiratory support and non-invasive monitoring, therefore reducing ICU burden. Older age and chronic respiratory or renal conditions are associated with worse clinical outcomes, while treatment with systemic corticosteroids may have a protective effect on mortality.

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The border territories of the specialty

Clarà¹,

Jerez²,

González³

2021

Archivos de Bronconeumología (English Edition)

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Cost and Mortality Analysis of an Intermediate Respiratory Care Unit. Is It Really Efficient and Safe?

Cited by 9 publications

References 17 publications

Impact of an Intermediate Respiratory Care Unit on Clinical Outcomes of COVID-19 Patients

Impact of an Intermediate Respiratory Care Unit on Clinical Outcomes of COVID-19 Patients

Clinical Outcomes of Severe COVID-19 Patients Admitted to an Intermediate Respiratory Care Unit

The border territories of the specialty

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