The educational-political activity of AIPO in the past 15 years has captured the interest of Pulmonologists for intensive care and achieved the institutional recognition of the Respiratory Intensive Care Units (RICUs) as care units for acute (ARF) or acute-on-chronic respiratory failure (ACRF). Aim of this study is to analyze the organizational evolution of Italian RICUs in the management of ARF/ACRF in the light of the second national AIPO survey data. Despite RICUs have increased from 26 to 44 units over the past 10 years, the number of beds surveyed is still below the estimated national demand. The geographical distribution of RICUs has been heterogeneous with a greater concentration in the North. The organizational model and the level of care turn out to be different with a greater development of the Monitoring Units within a pneumological ward compared to the Intermediate and Intensive Care Units, mostly functioning as autonomous units. The majority of RICUs have treated patients with ARF/ACRF in hospitals for acute, while a minority of them has dealt with weaning in Rehabilitation Centres. Consistent with the prevalent implementation of lower intensity of care models, average medical and nursing resources of RICUs have decreased. In contrast, their "efficiency" has increased with the reduction of admissions for only monitoring in favour to those for mechanical ventilation, weaning and decannulation. The pattern of disease has changed with a decrease in hospitalizations for COPD exacerbations in favour to those for neuro-myopathies decompensations and de novo hypoxemia. In conclusion, the Italian landscape photographed by this second survey - increasing number of RICUs and of complexity of interventions and disease treated - strengthens the role of Pulmonologist in the clinical governance of ARF/ACRF where these units are well structured. Further efforts are needed to expand the network of Italian RICUs and improve the training of Pulmonologists in intensive care.
The second AIPO survey on Respiratory Intensive Care Units in Italy between "scientific certainties and organisational criticisms"
Confalonieri M.;
2011-01-01
Abstract
The educational-political activity of AIPO in the past 15 years has captured the interest of Pulmonologists for intensive care and achieved the institutional recognition of the Respiratory Intensive Care Units (RICUs) as care units for acute (ARF) or acute-on-chronic respiratory failure (ACRF). Aim of this study is to analyze the organizational evolution of Italian RICUs in the management of ARF/ACRF in the light of the second national AIPO survey data. Despite RICUs have increased from 26 to 44 units over the past 10 years, the number of beds surveyed is still below the estimated national demand. The geographical distribution of RICUs has been heterogeneous with a greater concentration in the North. The organizational model and the level of care turn out to be different with a greater development of the Monitoring Units within a pneumological ward compared to the Intermediate and Intensive Care Units, mostly functioning as autonomous units. The majority of RICUs have treated patients with ARF/ACRF in hospitals for acute, while a minority of them has dealt with weaning in Rehabilitation Centres. Consistent with the prevalent implementation of lower intensity of care models, average medical and nursing resources of RICUs have decreased. In contrast, their "efficiency" has increased with the reduction of admissions for only monitoring in favour to those for mechanical ventilation, weaning and decannulation. The pattern of disease has changed with a decrease in hospitalizations for COPD exacerbations in favour to those for neuro-myopathies decompensations and de novo hypoxemia. In conclusion, the Italian landscape photographed by this second survey - increasing number of RICUs and of complexity of interventions and disease treated - strengthens the role of Pulmonologist in the clinical governance of ARF/ACRF where these units are well structured. Further efforts are needed to expand the network of Italian RICUs and improve the training of Pulmonologists in intensive care.Pubblicazioni consigliate
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