Increased Number and Expertise of Italian Respiratory High-Dependency Care Units: The Second National Survey

Abstract

.03), and the physician-to-patient mean ratio and the nurse-to-patient mean ratio per shift were lower (P ‫؍‬ .001 and P ‫؍‬ .002, respectively). Admissions for only monitoring decreased (P < .001), and admissions for active interventions increased: noninvasive ventilation (P ‫؍‬ .002), invasive ventilation (P < .001), weaning from invasive ventilation (P < .001), and tracheal decannulation (P < .001). The complexity of RHDCU patients' conditions increased: there was a reduction in the percentage of COPD patients (P < .001) and an increase in the percentage of patients with neuromyopathies (P < .001) and de novo hypoxemia (P ‫؍‬ .006). CONCLUSIONS: Between 1997 and 2007 there was an increase in the number and expertise of Italian RHDCUs, with a shift toward less expensive care, and greater complexity of interventions and patient dysfunctions. These findings support the crucial role of RHDCUs in the management of respiratory critical patients.

An International Survey on Noninvasive Ventilation Use for Acute Respiratory Failure in General Non-Monitored Wards

“…We developed a questionnaire to obtain data regarding hospital, general ward (outside ICU, non-monitored ward) or respiratory intermediate unit (characterized by a nurse/patient ratio of 1:3-1:4, multivariable monitors, NIV or invasive ventilation allowed, immediate availability of a physician) 17 ; ICU characteristics, settings, and modalities of NIV application and monitoring; perceived outcomes; technical and organizational aspects; and observed complications. The questionnaire was evaluated for clarity and relevance by an international panel of NIV experts (see the supplementary materials at http://www.rcjournal.com).…”

Respiratory High-Dependency Care Units in Italy

“…7,8 Respiratory highdependence care units (RHDCUs) are expected to relieve bed shortages in the ICU, to provide a high level of nursing assistance, to manage patients with acute-on-chronic respiratory failure who need NIV, to provide a multidisciplinary rehabilitative approach, and to serve as bridge to home-care programs or long-term care facilities. [9][10][11] SEE THE ORIGINAL STUDY ON PAGE 1100 In this issue of RESPIRATORY CARE, Scala and colleagues report an Italian national survey performed in 2007 that analyzed the temporal trends in the number, structures, staff, procedures, diagnosis, and outcomes of RHDCU in Italy, 12 and compare their findings to the previous Italian national RHDCU survey in 1997. 13 The RHDCUs were classified according to a European Respiratory Society task force report that defined 3 different levels of care: respiratory intensive care unit, respiratory intermediate care unit, and respiratory monitoring units.…”

“…13 The RHDCUs were classified according to a European Respiratory Society task force report that defined 3 different levels of care: respiratory intensive care unit, respiratory intermediate care unit, and respiratory monitoring units. 11 The 2007 survey 12 found an increase in the total number of RHDCUs, that the patients in the RHDCUs were more complex than in 1997, and that there has been a reduction in the RHDCUs' medical and nursing staff resources.…”

“…A similar trend of an increase in the complexity of patients and decrease in staff resources between 1991 and 2005 was recently reported by 5 Italian respiratory ICUs in Northern Italy, 14 which were among the RHDCUs described by Scala and colleagues. 12 A worsening in the main clinical outcomes of patients admitted to these units was associated with the reduced numbers of doctors, and drew attention to the potential further negative influence of reduced staffing on the rates of weaning success and home discharge, and stay. 14 Contrary to what might be expected, the association of more active interventions (including NIV and invasive ventilation, weaning from invasive ventilation, and tracheal decannulation), as opposed to monitoring only, increased the complexity of the care of the patients admitted, but the staffing reduction described by Scala and colleagues 12 did not result in worse clinical outcomes, compared to the previous survey.…”

“…12 A worsening in the main clinical outcomes of patients admitted to these units was associated with the reduced numbers of doctors, and drew attention to the potential further negative influence of reduced staffing on the rates of weaning success and home discharge, and stay. 14 Contrary to what might be expected, the association of more active interventions (including NIV and invasive ventilation, weaning from invasive ventilation, and tracheal decannulation), as opposed to monitoring only, increased the complexity of the care of the patients admitted, but the staffing reduction described by Scala and colleagues 12 did not result in worse clinical outcomes, compared to the previous survey. This may reflect an increase in Italian RHDCUs' expertise in dealing with critically ill patients, despite the finding that the most prevalent growth was in the lower-level (ie, respiratory monitoring) units, as Scala et al point out.…”