Patients’ characterization, hospital course and clinical outcomes in five Italian Respiratory Intensive Care Units

Background: Respiratory intensive care units (RICU) dedicated to weaning could be suitable facilities for clinical management of “post-ICU” patients Methods: We retrospectively analyzed the time course of patients' characteristics, clinical outcomes and sanitary staff utilization in 5 Italian RICU by comparing 3 periods of 5 consecutive years (from 1991 to 2005). Results: 3,106 patients (age, 76±4 yrs; 72% males) were analyzed. The number of co-morbidities per patient (from 1.8 to 3.0, p=0.05) and the previous intensive care unit stay (from 25 to 32 days, p=0.002) increased over time. The doctor-to-patients ratio significantly decreased over time (from 1:3 to 1:5, p<0.01) while the physiotherapist-to-patients ratio mildly increased (from 1:6 to 1:4.5, p<0.05). The overall weaning success rate decreased (from 87% to 66%, p<0.001) and the discharge destination changed (p<0.001) over time; less patients were discharged to home (from 22% to 10%), and more patients to nursing home (from 3% to 6%), acute hospitals (from 6% to 10%) and rehabilitative units (from 70% to 75%). The mortality rate increased over time (from 9% to 15%). Significant correlations between the doctor-to-patients ratio and the rates of weaning success (r=0.679, p=0.005), home discharge (r=0.722, p=0.002), and the RICU length of stay (LOS) (r=-0.683, p=0.005) were observed.Conclusions: The clinical outcomes of our units worsened over 15 years, likely as consequence of admitting more severely-ill patients. The potential negative influence of reduced medical staff availability on weaning success, home discharge and LOS warrants further prospective investigations.