Objectives: During the COVID-19 pandemic, the risk of collapse for the health system created great difficulties. We will demonstrate that intermediate respiratory care units (IRCU) provide adequate management of patients with non-invasive respiratory support, which is particularly important for patients with SARS-CoV-2 pneumonia. Methods: A prospective observational study of patients with COVID-19 admitted to the ICU of a tertiary hospital. Sociodemographic data, comorbidities, pharmacological, respiratory support, laboratory and blood gas variables were collected. The overall cost of the unit was subsequently analyzed. Results: 991 patients were admitted, 56 to the IRCU (from a of 81 admitted to the critical care unit). Mean age was 65 years (SD 12.8), Barthel index 75 (SD 8.3), Charlson comorbidity index 3.1 (SD 2.2), HTN 27%, COPD 89% and obesity 24%. A significant relationship (p < 0.05) with higher mortality was noted for the following parameters: fever greater than or equal to 39 °C [OR 5.6; 95% CI (1.2–2.7); p = 0.020], protocolized pharmacological treatment [OR 0.3; 95% CI (0.1–0.9); p = 0.023] and IOI [OR 3.7; 95% CI (1.1–12.3); p = 0.025]. NIMV had less of a negative impact [OR 1.8; 95% CI (0.4–8.4); p = 0.423] than IOI. The total cost of the IRCU amounted to €66,233. The cost per day of stay in the IRCU was €164 per patient. The total cost avoided was €214,865. Conclusions: The pandemic has highlighted the importance of IRCUs in facilitating the management of a high patient volume. The treatment carried out in IRCUs is effective and efficient, reducing both admissions to and stays in the ICU.

Obesity hypoventilation syndrome (OHS) is treated with non-invasive ventilation (NIV) that is titrated during polysomnography. Auto-adjusted NIV could obviate the need for polysomnographic titration, thereby reducing costs and delays in care. However, non-inferiority long-term clinical trials comparing auto-adjusted NIV with manually-adjusted NIV are lacking. To determine the comparative effectiveness of automatic vs manual NIV modality in OHS. In this multicenter, blinded, parallel group, non-inferiority and cost-effectiveness trial, we randomly assigned treatment-naïve ambulatory patients with OHS to auto-adjusted NIV (volume-targeted pressure support with auto-EPAP) or manually-adjusted NIV (bilevel PAP ST mode). The primary outcome was change in daytime PaCO₂ at 12 months, with the non-inferiority premise set at -2 mmHg. Secondary outcomes included symptoms, quality of life, and healthcare resource utilization. Intention-to-treat and per-protocol analyses were performed. 205 ambulatory patients with OHS were randomized, 107 to auto-adjusted NIV and 89 to manually-adjusted NIV. The mean [95% CI] improvement in PaCO₂ was -9.2 [-9.7;-8.7] mmHg in the auto-adjusted group and -8.7 [-9.1;-8.3] mmHg in the manually-adjusted group, with mean adjusted difference of 0.15 mmHg between groups ([low confidence limit -1.4]; non-inferiority P = 0.01). Cost-effectiveness was favorable to auto-adjusted group with a saving of 15287€(95% CI: -2370; -6854) per patient. There were no significant differences in other secondary outcomes. In ambulatory patients with OHS, auto-adjusted NIV had a non-inferior long-term effectiveness compared to manually-adjusted NIV while being more cost-effective. Auto-adjusted NIV may be preferred in clinical practice given its lower complexity and cost.

OBJETIVES: During the COVID-19 pandemic, the risk of collapse of the health system created great difficulties. We will demonstrate that Intermediate Respiratory Care Units (IRCU) provide adequate management of patients with non-invasive respiratory support, which is particularly important in patients with SARS-CoV-2 pneumonia. METHODS: A prospective observational study of patients with COVID-19 admitted to the ICU of a tertiary hospital. Sociodemographic data, comorbidities, pharmacological, respiratory support, laboratory and blood gas variables were collected. The overall cost of the unit was subsequently analyzed. RESULTS: 991 patients were admitted, 56 to the IRCU (of the 81 a critical care unit). Mean age was 65 years (SD 12.8), Barthel Index 75 (SD 8.3), Charlson 3.1 (SD 2.2), HTN 27%, COPD 89% and obesity 24%. Significant relationship (p <0.05) with higher mortality of the following: fever greater than or equal to 39oC [OR 5.6; 95% CI (1.2-2.7); p = 0.020], protocolized pharmacological treatment [OR 0.3; 95% CI (0.1-0.9); p = 0.023] and IOI [OR 3.7; 95% CI (1.1-12.3); p = 0.025]. NIMV showed less of a negative impact [OR 1.8; 95% CI (0.4-8.4); p = 0.423] than IOI. The total cost of the IRCUs amounted to €66,233. The cost per day of stay in the IRCU was €164 per patient. The total cost avoided was €214,865. CONCLUSION: The pandemic has highlighted the importance of IRCUs in facilitating the management of a high patient volume. The treatment carried out in IRCUs is effective and efficient, reducing both admissions to and stays in the ICU.

Analyze two IRCUs from the same health group located in hospitals of different levels of complexity. In the two units, the budgetary chapters and variables care process are described to estimate the costs derived per day of stay. The difference between the actual cost calculated at IRCU and the estimated cost for ICU will be considered as cost avoided. In the high complex IRCU, the costs avoided analysis due to non-stay in ICU was carried out, GRD (6). 97.6% of patients were admitted to the IRCU with 2224 days of stay with a direct complexity profit related with GRD of 448.000€. This stay is equivalent to a hospital expense of 1,791,120.64 € if the patient had been admitted to the ICU. The IRCU avoided cost were 543,000€. The total profit close to one million €/year. The daily cost of bed at IRCU being 561€/day. In the low-complexity IRCU GRD of 0.759. 64.9% patients were admitted to the ICU with 735.1 days of stay. They are equivalent to a hospital expense of 512,489,667€ if patient had been admitted to the ICU. The IRCU assumes its own expense of 377,371,463€, so the cost avoided per annual ICU stay is 135,118.204 €/year. The daily cost of bed at IRCU is 220 €/day. The efficiencies of the two units were determined by the sustained reduction in the mortality rate, re-entry rate, % of weaning’s. IRCUs are cost-effective. Specialization and a multidisciplinary team are essential

Home Mechanical Ventilation (HMV) is the proposed treatment therapy in patients with COPD and chronic respiratory failure with hypercapnia. A descriptive observational study of HMV has been carried in COPD patients from 2019 to 2022. Epidemiological and demographic data, COPD phenotype and pCO2, have been collected before and after the establishment of the HMV. The data has been compiled through the platform AirView ®Resmed. The software SAP was used to assemble data for admissions, emergency consultations and deaths and their relationship with the pressures used has been analysed: 68 patients were included, 50 were males (72%), median age was 71 years [55-86]. The predominant phenotype was emphysema (60.3%) and average airflow obstruction was 42.3% [15-117%]. ST mode was used predominantly with Lumis 150 ®Resmed device. The average IPAP was 17.04 cmH2O [10-24 cmH2O] and PEEP 8.91 cmH2O [5-13 cmH2O] with no differences between phenotypes. Average compliance was 7.66 [1.17-13.46 hours] and leakage 26.65 L/min [0-116]. There was a significant improvement in pCO2 in 52.4% patients. A significant relationship between the need for higher IPAP and PEEP was found with the number of emergency room visits (CC 0.35) and hospital admissions (CC 0.48). In conclusion, using higher pressures has been related to a significant gas exchange improvement and to a greater number of admissions and visits to the ER.

Home Mechanical Ventilation (HMV) in patients with COPD and stable hypercapnia is postulated as a recommended treatment but with a low level of evidence. The objective of this study is to assess what clinical characteristics and comorbidities are related to HMV failure and the consequences in terms of economical cost. Observational study of COPD carriers of HMV was performed. We performed a logistic regression using STATA, taking into account comorbidities as dependent variables, and calculating the ODDs Ratio with their confidence intervals (IC). The number of admissions, emergencies and deaths, were obtained through SAP, calculating the associated costs. We included 68 patients, 73% men aged 71 years [55-86 years]. The phenotype was emphysema (60.3%) and the obstruction was 42.3% [15-117%]; the prevalent comorbidity was obstructive sleep apnea. The average pCO2 prior to the start of the HMV was 57 mmHg [38-81] and the average pCO2 after initiation 46 mmHg [36-68]. A significant improvement is objectified (decrease >20% pCO2) after the establishment of HMV. There were 61 admissions, 53 emergency room, 489 consultations and only 2 deaths. The patient with hospital admissions, made a healthcare expenditure of around 9.200 Eur. The expenditure of those who required the least admissions as 126 Eur. Reduction pCO2 compared to the onset of HMV in 51.5% of patients. No comorbidities associated with HMV.