IMPACT OF RESPIRATORY COMPROMISE

Anderson et al. performed an analysis of the incidence of acute respiratory compromise (defined as acute respiratory failure requiring emergent assisted ventilation) in inpatient wards.¹ Data was collected from the Get With the Guidelines®* – Resuscitation registry, a multicenter national registry sponsored by the American Heart Association that records in-hospital cardiac arrests, medical emergency teams, and acute respiratory compromise events. Based on the number of events that occurred in participating hospitals, and the American Hospital Association’s hospital data set, the estimated incidence of acute respiratory compromise in the US was 44,551. The mortality rate for patients with acute respiratory compromise was 39.4%.¹

Among patients in the National Surgical Quality Improvement Program database who underwent abdominal wall reconstruction and experienced postoperative respiratory failure, defined as unplanned intubation or failure to wean after 48 hours, in-hospital mortality was significantly higher for patients suffering respiratory failure than for matched patients who did not experience postoperative respiratory failure.²

Among patients in the National Surgical Quality Improvement Program database who underwent abdominal wall reconstruction and experienced postoperative respiratory failure, defined as unplanned intubation or failure to wean after 48 hours, the median length of hospital stay was 15 days longer for patients suffering respiratory failure than for matched patients who did not experience postoperative respiratory failure.²

An analysis of national inpatient costs by the Healthcare Cost and Utilization Project determined that respiratory failure, insufficiency, and arrest was the 10th most expensive condition treated in US hospitals, totaling $8.7 billion in 2011.([FOOTNOTE=Torio, C. M., & Andrews, R. M. (2013). National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011: Statistical Brief #160 Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville MD.],[ANCHOR=],[LINK=]) Melamed et al. performed a retrospective controlled case study and found that patients who developed respiratory failure after orthopedic surgery had excess hospitalization costs of $26,571 compared to matched controls.([FOOTNOTE=Melamed, R., Boland, L. L., Normington, J. P., et al. Postoperative respiratory failure necessitating transfer to the intensive care unit in orthopedic surgery patients: risk factors, costs, and outcomes. Perioper Med (Lond). 2016;5:19.],[ANCHOR=],[LINK=])

A retrospective analysis of 8,113 consecutive cardiac surgery patients to determine predictors and outcome of recidivism in cardiac ICUs determined that respiratory failure requiring reintubation and ventilation was the primary reason for ICU recidivism.([FOOTNOTE=Vohra, H. A., Goldsmith, I. R., Rosin, M. D., Briffa, N. P., & Patel, R. L. The predictors and outcome of recidivism in cardiac ICUs. Eur J Cardiothorac Surg. 2005;27(3):508-511.],[ANCHOR=],[LINK=])

View Table: Primary reason for ICU recidivism among 8,113 consecutive cardiac surgery patients⁵