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. 2001 May;56(5):373–378. doi: 10.1136/thorax.56.5.373

Respiratory intensive care units in Italy: a national census and prospective cohort study

M Confalonieri 1, M Gorini 1, N Ambrosino 1, C Mollica 1, A Corrado 1
PMCID: PMC1746048  PMID: 11312406

Abstract

BACKGROUND—In Italy, respiratory intensive care units (RICUs) provide an intermediate level of care between the intensive care unit (ICU) and the general ward for patients with single organ respiratory failure. Because of the lack of official epidemiological data in these units, a two phase study was performed with the aim of describing the work profile in Italian RICUs.
METHODS—A national survey of RICUs was conducted from January to March 1997 using a questionnaire which comprised over 30 items regarding location, models of service provision, staff, and equipment. The following criteria were necessary for inclusion of a unit in the survey: (1) a nurse to patient ratio ranging from 1:2.5 to 1:4 per shift; (2) availability of adequate continuous non-invasive monitoring; (3) expertise for non-invasive ventilation (NIV) and for intubation in case of NIV failure; (4) physician availability 24 hours a day. Between November 1997 and January 1998 a 3 month prospective cohort study was performed to survey the patient population admitted to the RICUs.
RESULTS—Twenty six RICUs were included in the study: four were located in rehabilitation centres and 22 in general hospitals. In most, the reported nurse to patient ratio ranged from 1:2 to 1:3, with 36% of units reporting a ratio of 1:4 per shift. During the study period 756 consecutive patients of mean (SD) age 68 (12) years were admitted to the 26 RICUs. The highest proportion (47%) were admitted from emergency departments, 19% from other medical wards, 18% were transferred from the ICU, 13% from specialist respiratory wards, and 2% were transferred following surgery. All but 32 had respiratory failure on admission. The reasons for admission to the RICU were: monitoring for expected clinical instability (n=221), mechanical ventilation (n=473), and weaning (n=59); 586 patients needed mechanical ventilation during their stay in the RICU, 425were treated with non-invasive techniques as a first line of treatment (374 by non-invasive positive pressure, 51 by iron lung), and 161 underwent invasive mechanical ventilation (63 intubated, 98tracheostomies). All but 48 patients had chronic respiratory disease, mainly chronic obstructive pulmonary disease (COPD; n=451). More than 70% of patients (n=228) had comorbidity, mainly consisting of heart disorders. The median APACHE II score was 18 (range 1-43). The predicted inpatient mortality risk rate according to the APACHE II equation was 22.1% while the actual inpatient mortality rate was 16%. The mean length of stay in the RICU was 12 (11) days. The outcome in most patients (79.2%) admitted to RICUs was favourable.
CONCLUSIONS—Italian RICUs are specialised units mainly devoted to the monitoring and treatment of acute on chronic respiratory failure by non-invasive ventilation, but also to weaning from invasive mechanical ventilation. The results of this study provide a useful insight into an increasingly important field of respiratory medicine.



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Selected References

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  1. Auriant I., Vinatier I., Thaler F., Tourneur M., Loirat P. Simplified acute physiology score II for measuring severity of illness in intermediate care units. Crit Care Med. 1998 Aug;26(8):1368–1371. doi: 10.1097/00003246-199808000-00023. [DOI] [PubMed] [Google Scholar]
  2. Bone R. C., Balk R. A. Noninvasive respiratory care unit. A cost effective solution for the future. Chest. 1988 Feb;93(2):390–394. doi: 10.1378/chest.93.2.390. [DOI] [PubMed] [Google Scholar]
  3. Brochard L., Mancebo J., Wysocki M., Lofaso F., Conti G., Rauss A., Simonneau G., Benito S., Gasparetto A., Lemaire F. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995 Sep 28;333(13):817–822. doi: 10.1056/NEJM199509283331301. [DOI] [PubMed] [Google Scholar]
  4. Byrick R. J., Mazer C. D., Caskennette G. M. Closure of an intermediate care unit. Impact on critical care utilization. Chest. 1993 Sep;104(3):876–881. doi: 10.1378/chest.104.3.876. [DOI] [PubMed] [Google Scholar]
  5. Connors A. F., Jr, Dawson N. V., Thomas C., Harrell F. E., Jr, Desbiens N., Fulkerson W. J., Kussin P., Bellamy P., Goldman L., Knaus W. A. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments) Am J Respir Crit Care Med. 1996 Oct;154(4 Pt 1):959–967. doi: 10.1164/ajrccm.154.4.8887592. [DOI] [PubMed] [Google Scholar]
  6. Corrado A., Confalonieri M. Respiratory high-dependency care units in Italy. Monaldi Arch Chest Dis. 1999 Oct;54(5):435–437. [PubMed] [Google Scholar]
  7. Dasgupta A., Rice R., Mascha E., Litaker D., Stoller J. K. Four-year experience with a unit for long-term ventilation (respiratory special care unit) at the Cleveland Clinic Foundation. Chest. 1999 Aug;116(2):447–455. doi: 10.1378/chest.116.2.447. [DOI] [PubMed] [Google Scholar]
  8. Elpern E. H., Silver M. R., Rosen R. L., Bone R. C. The noninvasive respiratory care unit. Patterns of use and financial implications. Chest. 1991 Jan;99(1):205–208. doi: 10.1378/chest.99.1.205. [DOI] [PubMed] [Google Scholar]
  9. Fagon J. Y., Chastre J., Hance A. J., Montravers P., Novara A., Gibert C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med. 1993 Mar;94(3):281–288. doi: 10.1016/0002-9343(93)90060-3. [DOI] [PubMed] [Google Scholar]
  10. Gracey D. R., Hardy D. C., Naessens J. M., Silverstein M. D., Hubmayr R. D. The Mayo Ventilator-Dependent Rehabilitation Unit: a 5-year experience. Mayo Clin Proc. 1997 Jan;72(1):13–19. doi: 10.4065/72.1.13. [DOI] [PubMed] [Google Scholar]
  11. Gracey D. R., Viggiano R. W., Naessens J. M., Hubmayr R. D., Silverstein M. D., Koenig G. E. Outcomes of patients admitted to a chronic ventilator-dependent unit in an acute-care hospital. Mayo Clin Proc. 1992 Feb;67(2):131–136. doi: 10.1016/s0025-6196(12)61313-5. [DOI] [PubMed] [Google Scholar]
  12. Hill A. T., Hopkinson R. B., Stableforth D. E. Ventilation in a Birmingham intensive care unit 1993-1995: outcome for patients with chronic obstructive pulmonary disease. Respir Med. 1998 Feb;92(2):156–161. doi: 10.1016/s0954-6111(98)90088-9. [DOI] [PubMed] [Google Scholar]
  13. Knaus W. A., Draper E. A., Wagner D. P., Zimmerman J. E. APACHE II: a severity of disease classification system. Crit Care Med. 1985 Oct;13(10):818–829. [PubMed] [Google Scholar]
  14. Latriano B., McCauley P., Astiz M. E., Greenbaum D., Rackow E. C. Non-ICU care of hemodynamically stable mechanically ventilated patients. Chest. 1996 Jun;109(6):1591–1596. doi: 10.1378/chest.109.6.1591. [DOI] [PubMed] [Google Scholar]
  15. Leeson-Payne C. G., Aitkenhead A. R. A prospective study to assess the demand for a high dependency unit. Anaesthesia. 1995 May;50(5):383–387. doi: 10.1111/j.1365-2044.1995.tb05988.x. [DOI] [PubMed] [Google Scholar]
  16. Muir J. F., Mayaud C., Derenne J. P. Respiratory high dependency care units (RHDCU) in France. Monaldi Arch Chest Dis. 1999 Oct;54(5):452–455. [PubMed] [Google Scholar]
  17. Nava S., Confalonieri M., Rampulla C. Intermediate respiratory intensive care units in Europe: a European perspective. Thorax. 1998 Sep;53(9):798–802. doi: 10.1136/thx.53.9.798. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Petty T. L., Lakshminarayan S., Sahn S. A., Zwillich C. W., Nett L. M. Intensive respiratory care unit. Review of ten years' experience. JAMA. 1975 Jul 7;233(1):34–37. [PubMed] [Google Scholar]
  19. Pingleton S. K. Complications of acute respiratory failure. Am Rev Respir Dis. 1988 Jun;137(6):1463–1493. doi: 10.1164/ajrccm/137.6.1463. [DOI] [PubMed] [Google Scholar]
  20. Plant P. K., Owen J. L., Elliott M. W. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet. 2000 Jun 3;355(9219):1931–1935. doi: 10.1016/s0140-6736(00)02323-0. [DOI] [PubMed] [Google Scholar]
  21. Portier F., Defouilloy C., Muir J. F. Determinants of immediate survival among chronic respiratory insufficiency patients admitted to an intensive care unit for acute respiratory failure. A prospective multicenter study. The French Task Group for Acute Respiratory Failure in Chronic Respiratory insufficiency. Chest. 1992 Jan;101(1):204–210. doi: 10.1378/chest.101.1.204. [DOI] [PubMed] [Google Scholar]
  22. Roussos C., Rossi A. Pulmonologists and respiratory intensive care. Eur Respir J. 1996 Feb;9(2):183–183. doi: 10.1183/09031936.96.09020183. [DOI] [PubMed] [Google Scholar]
  23. Scheinhorn D. J., Artinian B. M., Catlin J. L. Weaning from prolonged mechanical ventilation. The experience at a regional weaning center. Chest. 1994 Feb;105(2):534–539. doi: 10.1378/chest.105.2.534. [DOI] [PubMed] [Google Scholar]
  24. Stauffer J. L., Olson D. E., Petty T. L. Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients. Am J Med. 1981 Jan;70(1):65–76. doi: 10.1016/0002-9343(81)90413-7. [DOI] [PubMed] [Google Scholar]
  25. Vitacca M., Clini E., Scalvini S., Foglio K., Quadri A., Levi G. Cardiopulmonary intermediate intensive unit: time course of two years activity. Monaldi Arch Chest Dis. 1993 Aug;48(4):296–300. [PubMed] [Google Scholar]

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