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Objective: The role of respiratory intermediate care units in the management of critically ill patients has been recently evaluated in Europe.A respiratory intermediate care unit was established two years ago in our 200-bed pneumology ward. It has 6 beds and has the availability of both invasive and noninvasive ventilatory support. Our aim is to make a two years’ analysis of our unit. 179 patients were admitted to our respiratory care unit either from the emergency department, pneumology ward or from the general intensive care unit.
Design: A retrospective study.
Setting: A six-bed respiratory intermediate care unit at the University of Ankara.
Patients: Records of 144 episodes of acute attacks, which were eligible for the study, were analyzed retrospectively. 37 cases were admitted to the unit for monitorization for hemodynamic instability, 84 received noninvasive ventilatory support and 23 invasive ventilatory support.
Measurements and Results: The mean age was 59.94±12.92 years (mean±SD). The average length of stay was 12.65±9.63 days.
Patients with acute respiratory failure due to chronic obstructive pulmonary disease (COPD), chest wall deformities, sequela of tuberculosis, idiopathic pulmonary fibrosis (IPF), bronchiectasis, obstructive sleep apnea (OSA) and obesity-hypoventilation syndrome and pneumonia received ventilatory support; either invasive or noninvasive.Decompansated respiratory acidosis (pH:7.29±0.06), severe hypoxemia, hypercapnia were present on admission of the patients, who were noninvasively ventilated. APACHE II scores of the noninvasive group was 18.39+4.49. The blood gas parameters improved significantly with noninvasive intermittent positive pressure ventilation with a daily application of at least 8 hours.
In the invasive group ABG revealed PaCO2: 72.98±25.49, mmHg, PaO2: 40.36±8.57, pH: 7.23±0.13. APACHE II score of this group was 22.65±7.23.The overall mortality rate under ventilatory support was 20.5%. These patients mostly had end-stage disease with concomitant other organ failures. When the blood gas analysis, age and APACHE II scores were evaluated as the determinants of survival, APACHE scores seemed to predict survival significantly (p<0.05)
Conclusion: Respiratory care unit is beneficial in the follow up of patients with acute respiratory failure in terms of close monitorization and ventilatory support.