Twenty Years of Respiratory Intermediate Care: Clinical Outcomes, Safety Indicators, and Resource Utilization in a Respiratory Intermediate Care Unit.

Background

Respiratory Intermediate Care Units (RICUs) are specialized units between conventional hospitalization and intensive care units (ICU), designed to manage patients with acute respiratory failure who require advanced respiratory support and monitoring, but do not necessarily require invasive mechanical ventilation (IMV).

Objective

To describe the clinical outcomes, safety indicators, and estimated financial impact and resource utilization of a RICU over a 20-year period.

Methods

Retrospective study (2003-2023) of all patients admitted to the RICU of a tertiary level hospital in Spain between January 2003 and December 2023. Analysed activities include: non-invasive mechanical ventilation (NIMV), high-flow oxygen therapy (HFOT), weaning from IMV, and interventional procedures. Primary outcomes included mortality, intubation rate, and length of stay (LOS). Financial impact was estimated by comparing the observed RICU costs with a theoretical ICU scenario.

Results

Seven thousand six hundred fifty-four patients were included (mean age 67±14 years, 62% male). The main diagnoses were: COVID-19 pneumonia (30.6%), chronic obstructive pulmonary disease exacerbation (28.7%), and severe pneumonia (22.2%). Additionally, 18.3% were IMV weaning admissions. Overall mortality was 8.4%, and the intubation rate was 12.1%. Among the patients admitted for weaning, survival reached 91.8%. The mean LOS was 6.9 days. Financial impact assessment estimated an average daily cost of €587 for RICU care compared with €940 for the theoretical ICU scenario, corresponding to an estimated annual difference of €485,000.

Conclusions

Over a 20-year period, this RICU provided specialized care for a large cohort of patients with acute respiratory failure, achieving favourable clinical outcomes with a lower estimated resource utilisation and costs.