title: Management of hypoxaemic respiratory failure in a Respiratory High-dependency Unit.
abstract: BACKGROUND
  There are limited data on outcomes of hypoxaemic respiratory failure (HRF), especially in non-intensive care unit (ICU) settings.
  
  
  OBJECTIVE
  To assess outcomes in HRF (without multi-system disease and not requiring early intubation) of patients directly admitted to a Respiratory High-dependency Unit (R-HDU).
  
  
  METHODS
  This is a 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 chronic obstructive pulmonary disease (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). A total of 18% with HRF was 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Craig
authors.identifier: http://orcid.org/0000-0002-6951-6852
authors.initials: C
authors.lastname: Hukins
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Mimi
authors.initials: M
authors.lastname: Wong
authors.affiliation: Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Murphy
authors.affiliation: Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Upham
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D006757:Hospital Units / Q000639:trends*; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis* / Q000628:therapy*; D007362:Intensive Care Units / Q000639:trends; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods / Q000639:trends; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000628:therapy*; D012189:Retrospective Studies
keywords: Respiratory High-dependency Unit; hypoxaemic respiratory failure; intensive care units; non-invasive ventilation; survival