PT - JOURNAL ARTICLE AU - Ilaria Valentini AU - Angela Maria Grazia Pacilli AU - Paolo Carbonara AU - Luca Fasano AU - Rita Vitale AU - Corrado Zenesini AU - Rita Maria Melotti AU - Stefano Faenza AU - Stefano Nava TI - INFLUENCE OF THE ADMISSION PATTERN ON THE OUTCOME OF PATIENTS ADMITTED TO A RESPIRATORY INTENSIVE CARE UNIT: DOES A STEP-DOWN ADMISSION DIFFER FROM A STEP-UP ONE? AID - 10.4187/respcare.02225 DP - 2013 Apr 30 TA - Respiratory Care PG - respcare.02225 4099 - http://rc.rcjournal.com/content/early/2013/04/30/respcare.02225.short 4100 - http://rc.rcjournal.com/content/early/2013/04/30/respcare.02225.full AB - Objective: The outcomes of patients admitted to a Respiratory Intensive Care Unit (RICU) have been evaluated in the past but no study has so far considered the influence of location prior to RICU admission Design: Prospectively collected data from a total of 326 consecutive patients were analyzed Settings: A 7-bed RICU (Respiratory Intensive Care Unit). Measurements: The primary endpoints were the patients’ survival and severity of morbidity-related complications, evaluated according to the patients’ location prior to the RICU admission. Three different admission pathways were considered: (i) “step-down” for patients transferred from the Intensive Care Units (ICU) of our hospital; (ii) “step-up” for patients coming from our Respiratory Wards (RW) or other Medical Wards (MW); and (iii) “directly” from the Emergency Room (ER). The secondary end-point was the potential influence of several risk factors for morbidity and mortality. Main results: Of the 326 patients, 92 (28%) died. Overall, patients admitted in a step-up process had a significantly higher mortality (p<0.001) than patients in the other groups. The mortality rate was 64% for patients admitted from RW, 43% for those from MW and 18% for patients from both ICU and ER (RW vs MW p<0.05; RW vs ER p<0.001; RW vs ICU p<0.001; MW vs ER p<0.001 and MW vs ICU p<0.001). Patients admitted from a RW had a lower albumin level and SAPS II score was significantly higher in patients following a step-up admission. About 30% of the patients admitted from a RW received non-invasive mechanical ventilation (NIV) as a “ceiling treatment”. The highest odds ratios related to survival were patients’ location prior to RICU admission and female gender. Lack of use of NIV, younger age, female gender, higher albumin level, lower SAPSII score, higher Barthel score and the absence of chronic heart failure were also statistically associated with a lower risk of death.