title: Increased number and expertise of italian respiratory high-dependency care units: the second national survey.
abstract: BACKGROUND
  The imbalance between the increasing prevalence of acutely decompensated respiratory diseases and the shortage of intensive care unit beds has stimulated the growth of respiratory high-dependence care units (RHDCUs).
  
  
  METHODS
  We conducted a national survey to analyze the changes, in the past 10 years, in the number, structures, staff, procedures, diagnoses, and outcomes in Italian RHDCUs that satisfy the European Respiratory Society's criteria (modified according to the Italian Association of Hospital Pneumologists) for high level (respiratory intensive care unit), intermediate level (respiratory intermediate intensive care unit), and low level (respiratory monitoring unit) RHDCU care.
  
  
  RESULTS
  The number of RHDCUs increased from 26 to 44. The relative prevalence among all the RHDCUs increased only for the low-level units (P = .03). Compared to 1997, in 2007 a higher percentage of Italian RHDCUs were located within respiratory wards than located outside of respiratory wards (P = .03), and the physician-to-patient mean ratio and the nurse-to-patient mean ratio per shift were lower (P = .001 and P = .002, respectively). Admissions for only monitoring decreased (P < .001), and admissions for active interventions increased: noninvasive ventilation (P = .002), invasive ventilation (P < .001), weaning from invasive ventilation (P < .001), and tracheal decannulation (P < .001). The complexity of RHDCU patients' conditions increased: there was a reduction in the percentage of COPD patients (P < .001) and an increase in the percentage of patients with neuromyopathies (P < .001) and de novo hypoxemia (P = .006).
  
  
  CONCLUSIONS
  Between 1997 and 2007 there was an increase in the number and expertise of Italian RHDCUs, with a shift toward less expensive care, and greater complexity of interventions and patient dysfunctions. These findings support the crucial role of RHDCUs in the management of respiratory critical patients.
authors.affiliation: Unità Operativa di Pneumologia, Unità di Terapia Semi-Intensiva Respiratoria e Interventistica, Ospedale Campo di Marte, Lucca, Italy. raffaele_scala@hotmail.com
authors.forename: Raffaele
authors.initials: R
authors.lastname: Scala
authors.forename: Antonio
authors.initials: A
authors.lastname: Corrado
authors.forename: Marco
authors.initials: M
authors.lastname: Confalonieri
authors.forename: Santino
authors.initials: S
authors.lastname: Marchese
authors.forename: Nicolino
authors.initials: N
authors.lastname: Ambrosino
mesh_terms: D001509:Bed Occupancy / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D012042:Registries / Q000706:statistics & numerical data*; D012121:Respiration, Artificial; D012124:Respiratory Care Units / Q000458:organization & administration*; D012189:Retrospective Studies