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Vol. 45. Issue 11.
Pages 533-539 (November 2009)
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Vol. 45. Issue 11.
Pages 533-539 (November 2009)
Original article
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A Year's Experience in an Intermediate Respiratory Care Unit
Cuidados respiratorios intermedios: un año de experiencia
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Myriam Aburtoa,
Corresponding author
, Cristóbal Estebana, Urko Aguirreb, Mikel Egurrolaa, Lander Altubea, Francisco Javier Morazaa, Alberto Capelasteguia
a Servicio de Neumología, Hospital de Galdakao, Galdakao, Bizkaia, Spain
b Unidad de Investigación-CIBER de Epidemiología y Salud Pública (CIBERESP), Hospital de Galdakao, Galdakao, Bizkaia, Spain
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Abstract
Background

The aim of this study was to describe the characteristics and results of patients admitted to an intermediate respiratory care unit (IRCU).

Patients and methods

We performed a 12-month prospective observational study of all the patients admitted to our IRCU during the study period. We analysed sociodemographic and clinical variables, the APACHE-II score, blood gas parameters, hospital stay duration, mortality, and hospital readmission.

Results

We evaluated 190 patients (64.2% men), with a mean age of 69.4 years. A score of greater than 2 on the Charlson index was recorded in 43.2% of patients. The mean APACHE-II score was 16.3 in the accident and emergency department and 14.3 on entering the IRCU. Fifty percent of the patients were admitted to receive ventilation and, of these, only 6 (5.7%) were admitted to be disconnected from the ventilator. The mean duration of stay in the IRCU was 3.7 days. The readmission rate was 12.7%. Mortality was 12.6% during hospitalisation and 11.6% 90 days after discharge.

Conclusions

The patients admitted to our IRCU were elderly, with considerable comorbidity and high mortality, both during hospitalisation and 90 days after being discharged from hospital. The results revealed no statistically significant differences (mean length of stay, readmission, mortality) according to the type of care administered to the patients (ventilation compared to monitoring).

Keywords:
Intermediate respiratory intensive care units
Non-invasive mechanical ventilation
Respiratory failure
Resumen
Introducción

El objetivo del presente estudio es describir las características y resultados de los pacientes ingresados en una unidad de cuidados respiratorios intermedios (UCRI).

Pacientes y métodos

Se ha realizado un estudio prospectivo y observacional de un año de duración, en el que se estudió a todos los pacientes ingresados en nuestra UCRI durante ese período. Se analizaron variables sociodemográficas, clínicas, escala APACHE-II, evolución gasométrica, duración de la estancia hospitalaria, mortalidad y reingreso hospitalario.

Resultados

Evaluamos a 190 pacientes (un 64,2% varones), con una edad media de 69,4 años. El 43,2% tenía un índice de Charlson mayor de 2. El APACHE-II fue de 16,3 en el Servicio de Urgencias y de 14,3 al entrar en la UCRI. El 50% de los pacientes ingresó para recibir ventilación, y de ellos sólo 6 (5,7%) ingresaron para la desconexión del ventilador. La duración media de la estancia en la UCRI fue de 3,7 días. La tasa de reingresos fue del 12,7%. La mortalidad fue del 12,6% durante el episodio de hospitalización, y del 11,6% a los 90 días del alta.

Conclusiones

Los ingresados en nuestra UCRI son pacientes mayores, con importante comorbilidad y mortalidad elevada, tanto durante el episodio de hospitalización como a los 90 días del alta hospitalaria. No hemos encontrado diferencias estadísticamente significativas en los resultados (estancia media, reingresos, mortalidad) en función del tipo de cuidados (ventilación frente a seguimiento) administrados al paciente.

Palabras clave:
Unidad de cuidados respiratorios intermedios (UCRI)
Ventilación mecánica no invasiva
Insuficiencia respiratoria
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References
[1.]
T.L. Petty, S. Lakshminarayan, S.A. Sahn, C.W. Zwillich, L.M. Nett.
Intensive respiratory care unit. Review of ten's years experience.
JAMA, 233 (1975), pp. 34-37
[2.]
A. Corrado, C. Roussos, N. Ambrosino, M. Confalonieri, A. Cuvelier, M. Elliott.
European Respiratory Society Task Force on epidemiology of respiratory intermediate care in Europe. Respiratory intermediate care units: a European survey.
Eur Resp J, 20 (2002), pp. 1343-1350
[3.]
S. Nava, M. Confalioneri, C. Rampulla.
Intermediate respiratory intensive care units in Europe: a European perspective.
Thorax, 53 (1998), pp. 798-802
[4.]
A. Torres, M. Ferrer, J.B. Blanquer, M. Calle, V. Casolive, J.M. Echave, et al.
Unidades de cuidados respiratorios intermedios, Definición y características.
Arch Bronconeumol, 41 (2005), pp. 505-512
[5.]
G.E. Rosenthal, C.A. Sirio, L.B. Shepardson, D.L. Harper, A.J. Rotondi, G.S. Cooper.
Use of intensive care units for patients with low severity of illness.
Arch Intern Med, 158 (1998), pp. 1144-1151
[6.]
S.A. Ridley.
Intermediate care, possibilities, requirements and solutions.
Anaesthesia, 53 (1998), pp. 654-664
[7.]
R.J. Henning, D. McClish, B. Daly, H. Rearman, C. Franklin, D. Jackson.
Clinical characteristics and resource utilization of ICU patients: implications for organization of intensive care.
Crit Care Med, 15 (1987), pp. 264-269
[8.]
R.K. Oye, P.E. Bellamy.
Patterns of resource consumption in medical intensive care.
Chest, 99 (1991), pp. 685-689
[9.]
C. Junker, J. Zimmerman, C. Alzola, E. Draper, D. Wagner.
A multicenter description of intermediate care patients. Comparison with ICU low risk monitor patients.
Chest, 121 (2002), pp. 1253-1261
[10.]
F. Frutos, I. Alía, M.R. Lorenzo, J. García, M. Nolla, J. Ibáñez, et al.
Utilización de la ventilación mecánica en 72 unidades de cuidados intensivos de España.
Med Intensiva, 27 (2003), pp. 1-12
[11.]
Medical Research Council's Committee on environmental and occupational setting.
Questionnaire on respiratory symptoms.
MRC, (1986),
[12.]
M.E. Charslon, P. Pompei, K.L. Ales, C.R. MacKenzie.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
J Chron Dis, 40 (1987), pp. 373-383
[13.]
M.M. Oken, R.H. Creech, D.C. Tormey, J. Horton, T.E. Davis, E.T. McFadden, et al.
Toxicity and response criteria of the Eastern Cooperative Oncology Group.
Am J Clin Oncol, 5 (1982), pp. 649-655
[14.]
W.A. Knaus, D.P. Drapper, J.E. Zimmerman.
APACHE II: a severity of disease classification system.
Crit Care Med, 13 (1985), pp. 818-829
[15.]
P.P. España, A. Capelastegui, I. Gorordo, C. Esteban, M. Oribe, M. Ortega, et al.
Development and validation of a clinical prediction rule for severe communityacquired pneumonia.
Am J Respir Crit Care Med, 174 (2006), pp. 1249-1256
[16.]
M.J. Fine, T.E. Auble, D.M. Yealy, B.H. Hanusa, L.A. Weissfeld, D.E. Singer, et al.
A prediction rule to identify low-risk patients with community-acquired pneumonia.
N Engl J Med, 336 (1997), pp. 243-250
[17.]
D.V. Pilcher, M.J. Bailey, D.F. Treacher, S. Hamid, A.J. Williams, A.C. Davidson.
Outcomes cost and long term survival of patients referred to a regional weaning centre.
Thorax, 60 (2005), pp. 187-192
[18.]
P. Ceriana, M. Delmastro, C. Rampulla, S. Nava.
Demographics and clinical outcomes of patients admitted to a respiratory intensive care unit localized in a rehabilitation center.
Respir Care, 48 (2003), pp. 670-676
[19.]
B. Bertolini, M. Confalonieri, C. Rossi, G. Rossi, B. Simini, M. Gorini, et al.
Cost of COPD. Differences between intensive care unit and respiratory intermediate care unit.
Respir Med, 99 (2005), pp. 894-900
[20.]
C. Balaguer, E. Sala, M. Carrera, A. Palou, F. De Borja, J. Bover, et al.
Actividad de una unidad de cuidados respiratorios intermedios (UCRI) dependiente de un servicio de neumología durante el primer año de funcionamiento.
Arch Bronconeumol, 44 (2008), pp. 177
[21.]
M. Confalonieri, M. Gorini, C. Mollica, A. Corrado.
Respiratory intensive care units in Italy: a national census and prospective cohort study.
Thorax, 56 (2001), pp. 373-378
[22.]
E. Elpern, M. Silver, R. Rosen, R. Bone.
The non-invasive respiratory care unit. Patterns of use and financial implications.
Chest, 99 (1991), pp. 205-208
[23.]
P.K. Plant, J.L. Owen, M.W. Elliot.
Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general, respiratory wards: a multicentre randomised controlled trial.
Lancet, 355 (2000), pp. 1931-1933
[24.]
L. Brochard, J. Mancebo, M. Wysocki, G. Lofaso Conti, A. Rauss, G. Simonneau, et al.
Non invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease.
N Engl J Med, 333 (1995), pp. 817-833
[25.]
J. Phua, K. Kong, K.J. Lee, L. Shen, T.K. Lim.
Non-invasive ventilation in hypercapnic acute respiratory failure due to chronic obstructive pulmonary disease vs. other conditions: effectiveness and predictors of failure.
Intensive Care Med, 31 (2005), pp. 533-539
[26.]
R. Scala, M. Naldi, I. Archinucci, G. Coniglio, S. Nava.
Non-invasive positive pressure ventilation in patients with acute exacerbations of COPD and varying levels of consciousness.
Chest, 128 (2005), pp. 1657-1666
[27.]
A. Carlucci, J.C. Richard, M. Wysocki, E. Lepage, L. Brochard, The SRLF collaborative group on mechanical ventilation.
Noninvasive versus conventional mechanical ventilation.
Am J Respir Crit Care Med, 163 (2001), pp. 874-880
[28.]
E. Paus-Jenssen, J.K. Reis, D.W. Cockcroft, K. Lamframboise, H. Ward.
The use of noninvasive ventilation in acute respiratory failure at tertiary care center.
Chest, 126 (2004), pp. 165-172
[29.]
A. Ortega, G. Peces-Barba, I. Fernández, R. Chumbi, N. Cubero, N. González.
Evolución comparativa con ventilación no invasiva de pacientes con EPOC, síndrome de hipoventilación-obesidad e insuficiencia cardíaca congestiva ingresados en una unidad de monitorización respiratoria.
Arch Bronconeumol, 42 (2006), pp. 423-429
[30.]
A. Aggarwal, P. Sarkar, D. Gupta, K. Jindal.
Performance of standard severity scoring systems for outcome prediction in patients admitted to a respiratory intensive care unit in North India.
Respirology, 11 (2006), pp. 196-204
[31.]
M. Vitacca, L. Bianchi, L. Barbano, M. Ziliani, N. Ambrosino.
Effects of acute on chronic respiratory failure on hypercapnia and 3-month survival.
Chest, 128 (2005), pp. 1209-1215
[32.]
E. Sala.
Unidades de cuidados intermedios en neumología.
Arch Bronconeumol, 44 (2008), pp. 1-2
[33.]
E. Chiner, M. LLombart, M.A. Martínez-García, E. Fernández-Cambreñas, R. Navarro, L. Cervera.
Ventilación mecánica no invasiva en la Comunidad Valenciana: de la teoría a la práctica.
Arch Bronconeumol, 45 (2009), pp. 118-122
Copyright © 2009. Sociedad Española de Neumología y Cirugía Torácica
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