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Management of Hypoxaemic Respiratory Failure in a Respiratory High Dependency Unit.
Intern Med J. 2017 Feb 22;:
Authors: Hukins C, Wong M, Murphy M, Upham J
Abstract
BACKGROUND: There are limited data on outcomes of hypoxaemic respiratory failure (HRF), especially in non-ICU settings.
AIM: To assess outcomes in HRF (without multi-system disease and not requiring early intubation) directly admitted to a Respiratory High Dependency Unit (R-HDU).
METHODS: Retrospective, cohort study of HRF compared to Hypercapnic Respiratory Failure (HCRF) in a R-HDU (2007-2011). Patient characteristics (age, gender, pre-morbid status, diagnoses) and outcomes (non-invasive ventilation (NIV) use, survival, ICU admission) were assessed.
RESULTS: There were 1207 R-HDU admissions in 2007-2011 (205 (17%) with HRF and 495 (41%) with HCRF). The proportion with HRF increased from 12.2% in 2007 to 20.1% in 2011 (p < 0.05). HRF patients were younger, more often male and had better pre-morbid performance. Compared to HCRF, HRF was more frequently associated with lung consolidation (61% vs 15%, P < 0.001), interstitial lung disease (12% vs 1%, P < 0.001) and pulmonary hypertension (7% vs 0%, P < 0.001) and less frequently with COPD (24% vs 65%, p < 0.001) and obstructive sleep apnoea (8% vs 26%, p < 0.001). Fewer patients with HRF were treated with NIV (28% vs 87%, p < 0.001) but NIV was discontinued early more often (28% vs 7%, p < 0.001). 18% with HRF were transferred to ICU compared to 6% with HCRF (p = 0.06). More patients with HRF died (19.5% vs 12.3%, p = 0.02). Interstitial lung disease, consolidation, shock, malignancy and poorer pre-morbid function were associated with increased mortality.
CONCLUSION: Initial R-HDU management is an effective option in selected HRF to reduce ICU demand, although mortality and clinical deterioration despite NIV are more common than in HCRF.
PMID: 28224729 [PubMed - as supplied by publisher]