Respiratory intermediate care units: a European survey

Corrado, Antonio; Roussos, Ch.; Ambrosino, Nicolino; Confalonieri, Marco; Cuvelier, A.; Elliott, Mark; Ferrer, Miquel; Gorini, Massimo; Gürkan, Özlem Ural; Muir, Jean-François; Quareni, L.; Robert, Dominique; Rodenstein, Daniel; Rossi, Andrea; Schoenhofer, Bernd; Simonds, Anita K.; Ström, Kerstin; Torres, Antoni; Zakynthinos, Spyros

doi:10.1183/09031936.02.00058202

Cited by 108 publications

(8 citation statements)

References 37 publications

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“…In light of this, we should also acknowledge as limitation of our study the fact that we were not able to calculate an exact sample size of the study population. The strength of this study is the evaluation of consecutively enrolled patients in six Italian HDUs with long experience in the NIV use [ 20 ]. Furthermore, this is the largest cohort of DILD patients specifically treated with NIV, outside the ICU.…”

Section: Discussionmentioning

confidence: 99%

Non-invasive mechanical ventilation in patients with diffuse interstitial lung diseases

et al. 2014

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BackgroundTo evaluate noninvasive ventilation (NIV) in diffuse interstitial lung diseases (DILD) patients with acute respiratory failure (ARF) according to baseline radiological patterns and the etiology of ARF.MethodsIn a multicenter, observational, retrospective study, consecutive DILD patients undergoing NIV because of an episode of ARF were evaluated in six Italian high dependency units. Three groups of patients were identified based on the etiology of ARF: those with pneumonia (Group A), those with acute exacerbation of fibrosis, (Group B) and those with other triggers (Group C). Clinical failure was defined as any among in-hospital mortality, endotracheal intubation and extra-corporeal membrane oxygenation use.ResultsAmong the 60 patients enrolled (63% males; median age: 71 years), pneumonia (42%) and acute exacerbation of fibrosis (39%) were the two most frequent causes of ARF. A significant increase of PaO2/FiO2 ratio during NIV treatment was detected in Group A (p = 0.010), but not in Group B. No significant difference in PaO2/FiO2 ratio, PaCO2 and pH values during NIV treatment was detected in patients with a radiological pattern of usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP). 22 patients (37%) suffered for a clinical failure. No significant differences in the study outcome were detected in Group A vs. Group B, as well as among patients with a radiological pattern of UIP vs. NSIP.ConclusionsNIV treatment should be individualized in DILD patients with ARF according to the etiology, but not the baseline radiological pattern, in order to improve oxygenation.

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Section: Discussionmentioning

confidence: 99%

Non-invasive mechanical ventilation in patients with diffuse interstitial lung diseases

et al. 2014

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“…The main advantage of the RICU for patients with AECOPD may be the timely and accurate use of NIV. According to the European Respiratory Society, the RICU (thanks to the presence of NIV-dedicated staff, the monitoring provided, and the expertise available) is an example of good management of hospital resources and allows the best outcome for AECOPD patients [6]. Nevertheless, some patients with AECOPD are still admitted to hospital units where NIV is not routinely available and used [18,19,20].…”

Section: Discussionmentioning

confidence: 99%

“…Some European surveys have found an association between high-quality specialized hospital care and better outcomes for patients with AECOPD [4,5]. Respiratory intermediate care units (RICUs) were introduced in Europe to improve the management and prognosis of patients with ARF, regardless of its etiology [6]. RICUs are specialized dedicated areas that aim to optimize the cost-benefit ratio in the care of these patients, mainly through the provision of a lower level of nursing intensity compared with general ICUs.…”

Section: Introductionmentioning

confidence: 99%

Opening of a Respiratory Intermediate Care Unit in a General Hospital: Impact on Mortality and Other Outcomes

Confalonieri¹,

Trevisan²,

Demsar³

et al. 2015

Respiration

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Background: Respiratory intermediate care units (RICUs) are specialized areas aimed at optimizing the cost-benefit ratio of care. No data exist about the impact of opening a RICU on hospital outcomes. Objectives: We wondered if opening a RICU may improve the outcomes of patients with acute respiratory failure (ARF), acute exacerbation of chronic obstructive pulmonary disease (AECOPD), or community-acquired pneumonia (CAP). Methods: We analyzed the discharge abstracts of 2,372 admissions to the RICU and internal medicine units (IMUs) for ARF, AECOPD, and CAP. The IMUs at the Hospital of Trieste comprise emergency and internal wards. In order to investigate the determinants of outcomes, a matched case-control study was performed using clinical records. Results: The in-hospital mortality rate was lower in the RICU vs. IMUs (5.4 vs. 19.1%, p = 0.0001). Statistical differences did not change when comparing the RICU with the emergency and internal wards. After adjusting for potential confounders, the risk of death for patients with CAP, AECOPD, or ARF was significantly higher in the IMUs than in the RICU (OR 6.90, 3.19, and 6.7, respectively, p < 0.04). Both the frequency of transfer to the ICU (6 vs. 12%, p = 0.0001, OR 0.38) and the hospital stay (9.3 vs. 12.1 days, p = 0.0001) were reduced in patients admitted to the RICU compared to those admitted to non-RICUs. Significant differences were found in care management concerning chest physiotherapy, mechanical ventilation, antibiotics, and corticosteroids. Conclusions: The opening of a RICU may be advantageous to reduce in-hospital mortality, the need for ICU admission, and the hospital stay of patients with AECOPD, CAP, and ARF. Better use of care resources contributed to better patient management in the RICU.

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“…NIV is routinely administered in specific units outside of the ICU, including step-down units, high-dependency units, emergency departments, and respiratory intermediate care units (RICUs). RICUs have grown in number because they allow for NIV to be performed on patients with less severe illness, with similar results as those reported in ICUs but at a lower cost [ 26 ]. Patients admitted to these units are frequently hemodynamically stable and without multiple organ failure, and they often have a do-not-intubate (DNI) order [ 26 , 27 ].…”

Section: Introductionmentioning

confidence: 92%

“…RICUs have grown in number because they allow for NIV to be performed on patients with less severe illness, with similar results as those reported in ICUs but at a lower cost [ 26 ]. Patients admitted to these units are frequently hemodynamically stable and without multiple organ failure, and they often have a do-not-intubate (DNI) order [ 26 , 27 ]. Currently, insufficient information is available to determine whether the same factors that predict NIV failure in ICU patients are applicable to RICU patients and whether a pH of <7.25 should be considered a contraindication to NIV in these patients.…”

Section: Introductionmentioning

confidence: 92%

Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units

et al. 2016

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BackgroundSevere acidosis can cause noninvasive ventilation (NIV) failure in chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure (AHRF). NIV is therefore contraindicated outside of intensive care units (ICUs) in these patients. Less is known about NIV failure in patients with acute cardiogenic pulmonary edema (ACPE) and obesity hypoventilation syndrome (OHS). Therefore, the objective of the present study was to compare NIV failure rates between patients with severe and non-severe acidosis admitted to a respiratory intermediate care unit (RICU) with AHRF resulting from ACPE, COPD or OHS.MethodsWe prospectively included acidotic patients admitted to seven RICUs, where they were provided NIV as an initial ventilatory support measure. The clinical characteristics, pH evolutions, hospitalization or RICU stay durations and NIV failure rates were compared between patients with a pH ≥ 7.25 and a pH < 7.25. Logistic regression analysis was performed to determine the independent risk factors contributing to NIV failure.ResultsWe included 969 patients (240 with ACPE, 540 with COPD and 189 with OHS). The baseline rates of severe acidosis were similar among the groups (45 % in the ACPE group, 41 % in the COPD group, and 38 % in the OHS group). Most of the patients with severe acidosis had increased disease severity compared with those with non-severe acidosis: the APACHE II scores were 21 ± 7.2 and 19 ± 5.8 for the ACPE patients (p < 0.05), 20 ± 5.7 and 19 ± 5.1 for the COPD patients (p < 0.01) and 18 ± 5.9 and 17 ± 4.7 for the OHS patients, respectively (NS). The patients with severe acidosis also exhibited worse arterial blood gas parameters: the PaCO2 levels were 87 ± 22 and 70 ± 15 in the ACPE patients (p < 0.001), 87 ± 21 and 76 ± 14 in the COPD patients, and 83 ± 17 and 74 ± 14 in the OHS patients (NS)., respectively Further, the patients with severe acidosis required a longer duration to achieve pH normalization than those with non-severe acidosis (patients with a normalized pH after the first hour: ACPE, 8 % vs. 43 %, p < 0.001; COPD, 11 % vs. 43 %, p < 0.001; and OHS, 13 % vs. 51 %, p < 0.001), and they had longer RICU stays, particularly those in the COPD group (ACPE, 4 ± 3.1 vs. 3.6 ± 2.5, NS; COPD, 5.1 ± 3 vs. 3.6 ± 2.1, p < 0.001; and OHS, 4.3 ± 2.6 vs. 3.7 ± 3.2, NS). The NIV failure rates were similar between the patients with severe and non-severe acidosis in the three disease groups (ACPE, 16 % vs. 12 %; COPD, 7 % vs. 7 %; and OHS, 11 % vs. 4 %). No common predictive factor for NIV failure was identified among the groups.ConclusionsACPE, COPD and OHS patients with AHRF and severe acidosis (pH ≤ 7.25) who are admitted to an RICU can be successfully treated with NIV in these units. These results may be used to determine precise RICU admission criteria.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0262-9) contains supplementary material, which is available to authorized users.

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Respiratory intermediate care units: a European survey

Cited by 108 publications

References 37 publications

Non-invasive mechanical ventilation in patients with diffuse interstitial lung diseases

Non-invasive mechanical ventilation in patients with diffuse interstitial lung diseases

Opening of a Respiratory Intermediate Care Unit in a General Hospital: Impact on Mortality and Other Outcomes

Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units

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