European Respiratory Society Task Force on epidemiology of respiratory intermediate care in Europe

CONTENTSMethods . . . 1344Results 1345Geographical distribution and typeof units . . 1345Location . 1345Type of intervention according to differentlevels of care . . 1345Patient population and infectivecomplications. . 1346Discussion 1347Appendix: Items of the questionnaire. ........1348Name of institution . . 1348Hospital characteristics 1348Structural characteristics of the respiratoryintermediate care unit . 1348Technical equipment. . 1348Facilities . . . . . . 1349Staff . . 1349Characteristics of patients andintervention . . . . 1349Severe chronic obstructive pulmonary disease (COPD)patients, especially those with chronic respiratoryfailure, may frequently require periods of intensivetreatment, monitoring, nursing and, occasionally,ventilatory assistance in order to overcome acuteexacerbations. Ventilatory assistance is only rarelyprovided in the conventional ward [1], thereforeadmission to an intensive care unit (ICU) is oftenneeded [2]. ICU, however, are very precious and expen-sive resources where nursing costs represent a majorexpense [3]. Patients with acute on chronic respiratoryfailure may experience a prolonged stay in the ICUnot only because of the severity of their illness whichprecipitates the underlying acute respiratory failure(ARF) [2], but also because of ICU-related complica-tions [4]. For these reasons the treatment of acute onchronically ill patients in these areas creates ethical [5]and economic concerns [6, 7].It has been reported that y40% of the patientsadmitted to ICUs never received active intensive care,including mechanical ventilation [8–10]. Onlyy40% ofpatients with ARF due to pulmonary disease neededto be invasively ventilated [11, 12]. However, in somecountries, such as the UK, with a severe ICU bedshortage, the vast majority of ICU admissions requiremechanical ventilation.A recent Italian survey carried out on 99 ICUsshowed that COPD was the dominant underlyingchronic disease in patients admitted to the Italian ICU,and the need for cardiorespiratory monitoring was themost frequent indication for admission (31.2%) [13].These studies clearly indicate that in some centresthere is an "overutilisation" of ICU resources formonitoring purposes, and that acute on chronic res-piratory failure could be managed in many patientswithout invasive ventilation.Patients with chronic respiratory failure, especiallythose with underlying COPD, very often suffer from ahigh frequency of acute exacerbations, which, whenrequiring invasive mechanical ventilation, may beassociated with life-threatening complications [4].Furthermore, it has been reported that in COPDpatients with ARF the greater part of their ICU staywas devoted to weaning the patient from mechanicalventilation, and this weaning period accounted for59% of the total duration of mechanical ventilation [14].