To characterize the different typologies of Respiratory Failure (RF) in terms of frequency, mean length of stay (LOS), type of discharge, comorbidity, procedures.
The Italian PneumoSTAR project provides discharge forms (DFs) of patients from respiratory care units since 1999 (236,000 total DFs). Since June 2003, the project focused also on RF, differentiating between Acute RF (ARF), chronic (CRF), acute on chronic RF (ACRF). We examined DFs in the period June-December 2003, reporting RF as principal (PD) or secondary (SD) diagnosis.
DFs with RF as PD or SD resulted 3,848 (27.6%): 38.6%-ARF, 28.6%-CRF, 32.8%-ACRF. M/F rate was 1.8; 84.9% was>60 years (68.9-ARF, 72.0-CRF, 72.0-ACRF). In 54.2% of cases RF was reported in PD (48.5%-ARF, 54.1%-CRF, 61.1%-ACRF). COPD was the prevalent SD (60.7%): 48.0% with exacerbation, 12.7% without exacerbation. RF was reported in SD in 45.8% (51.5%-ARF, 45.9%-CRF, 38.9%-ACRF); the prevalent PDs were: COPD (18.4%, with exacerbation 17.4%), pneumonia (26.6%). Prevalent procedures were: 32.2% oxygen therapy, 72.1% arterial blood gas-analysis, 16.8% mechanical ventilation, 11.5% non-invasive mechanical ventilation (14.2% for RF in PD, 8%-ARF, 10.7%-CRF, 22.7%-ACRF). DRG87 was the prevalent DRG for RF in PD: 91.8%. When RF was in SD the prevalent DRGs were: DRG88 (19.5%), DRG89 (17.0%), DRG92 (13.7%), DRG82 (9.8%), DRG79 (7.2%). The mean LOS was 12.1 (12.1-ARF, 11.3-CRF, 12.9-ACRF) and was significantly lower for RF in PD vs SD: 11.3 vs 13.2 (p<0.01). For RF in SD, DRGs 79 and 89 showed a mean LOS significantly higher than DRG88 (15.3 and 12.2 vs 10.5 p<0.01). Admission was mainly from emergency department (81.8%). Mortality rate was 7.2% for RF in PD (8.9%-ARF, 4.7%-CRG, 7.5%-ACRF) and 11.2% for RF in SD (15.4%-ARF, 6.9%-CRF, 9.2%-ACRF).
The DFs studied are mainly characterized by chronic, exacerbated pathology. Pneumonia seems to be responsible for a higher LOS, and is more represented in ARF. Nevertheless, further considerations are needed about comorbidity, e.g. COPD.
RF in SD is associated with a higher hospital mortality, specially when it is ARF.
L. Ballerin, None.