Analysis of mortality in an Intermediate Respiratory Care Unit (ICRU)

Introduction The development of non-invasive mechanical ventilation (NIMV), its scientific evidence and the need to monitor the most severe cases, has led to the creation of the IRCUs. In our hospital, we apply NIMV to patients with acute respiratory failure (ARF) or exacerbated chronic respiratory failure (ACRF).

Material and methods Prospective study of 220 non-Covid patients with ARF or ACRF who require NIMV and admission to the IRCU. General clinical and radiological data were collected and mortality was analyzed, as well as compared with the year 2019, when we did not have an IRCU.

Results Mean age 71 years, (56% men) and a Charlson Index (mean) of 6.4 points. The most frequent respiratory failure was hypercapnic 65% vs. hypoxemic 34%. After IRCU, 77% were referred to the ward, 5% to the Intensive Care Unit (ICU), and 17% died or began comfort measures. Mortality in the IRCU is significantly related to the data in the table.

There are 12% of patients who, having been discharged from the IRCU, finally die during the rest of their hospital stay. Of these, 3% are deaths of those admitted to the ICU, and 9% to deaths on the ward after discharge from the IRCU. Analyzing mortality, we found significant differences in terms of the service they belong to (Internal Medicine 41%), hypoxemic failure (58%), bilateral infiltrates (52%), age (80 years) and Charlson Index (7.8) ([Tab. 1]).

Tab. 1

Finally, we have compared mortality in the IRCU with that of 2019 when we did not have this Unit, using the hospital mortality data (not mortality in the IRCU as it was not available in 2019). For this, we have amnalyzed a representative saple of 53% of the most severe cases treated in 2019 with NIMV in the ward, according to Apache II, and which was similar in age and comorbidities to those admitted to the IRCU.

• Without IRCU: Age 70.6 years // Charlson 6.4 // ICU admission 15% // Hospital mortality 38%.

• With IRCU: Age 71 years // Charlson 6.4 // ICU admission 5% // Hospital mortality 29%

Conclusions Mortality is higher in hypoxemics, related to Charlson Index and infiltrates.

The opening of the IRCU has led to a decrease in hospital mortality for severe patients who require NIMV, and a 66% decrease in ICU admissions.

Publication History

Article published online:
09 March 2023