Respiratory Compromise as a New Paradigm for the Care of Vulnerable Hospitalized Patients.
Acute respiratory compromise describes a deterioration in respiratory function with a high likelihood of rapid progression to respiratory failure and death. Identifying patients at risk for respiratory compromise coupled with monitoring of patients who have developed respiratory compromise might allow earlier interventions to prevent or mitigate further decompensation. The National Association for the Medical Direction of Respiratory Care (NAMDRC) organized a workshop meeting with representation from many national societies to address the unmet needs of respiratory compromise from a clinical practice perspective. Respiratory compromise may arise de novo or may complicate preexisting lung disease. The group identified distinct subsets of respiratory compromise that present similar opportunities for early detection and useful intervention to prevent respiratory failure. The subtypes were characterized by the pathophysiological mechanisms they had in common: impaired control of breathing, impaired airway protection, parenchymal lung disease, increased airway resistance, hydrostatic pulmonary edema, and right-ventricular failure. Classification of acutely ill respiratory patients into one or more of these categories may help in selecting the screening and monitoring strategies that are most appropriate for the patient's particular pathophysiology. Standardized screening and monitoring practices for patients with similar mechanisms of deterioration may enhance the ability to predict respiratory failure early and prevent its occurrence.
Division of Pulmonary and Critical Care Medicine. University of California, San Diego, California. t1morris@ucsd.edu.
Timothy A
TA
Morris
Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
Peter C
PC
Gay
Division of Pulmonary, Allergy, and Critical Care Medicine. Duke University School of Medicine, Durham, North Carolina.
Neil R
NR
MacIntyre
Department of Respiratory Care, Massachusetts General Hospital and Department of Anesthesia, Harvard Medical School, Boston, Massachusetts.
Dean R
DR
Hess
Department of Acute and Continuing Care, School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas.
Sandra K
SK
Hanneman
Department of Medicine, Inova Fairfax Hospital, Annandale, Virginia.
James P
JP
Lamberti
Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky and the Lexington Veterans Administration Medical Center, Lexington, Kentucky.
Dennis E
DE
Doherty
Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill, North Carolina.
Lydia
L
Chang
Medical Intensive Care Unit, Christiana Care Health Services, Wilmington, Delaware.
Maureen A
MA
Seckel
D006760:Hospitalization; D006801:Humans; D008171:Lung Diseases / Q000150:complications*; D018579:Patient Selection; D012131:Respiratory Insufficiency / Q000209:etiology; D012307:Risk Factors; D059039:Standard of Care; D035862:Vulnerable Populations
quality improvement; respiratory compromise; respiratory failure