Intermediate respiratory intensive care units in Europe: a European perspective

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Abstract
The rationale for ICUs was formulated by the UK Working Party on Intensive Care in 1989 as “a service for patients with potentially recoverable disease who can benefit from more detailed observation and treatment that is not generally available in the standard ward and departments”.8 The increasing number of admissions to ICUs and the relatively high costs have given rise to wide discussion about the utilisation of ICU resources, not only from a medical point of view but also from economic, ethical, and political viewpoints. For example, it has been estimated that in the USA at the end of the 1980s the costs of intensive care medicine comprised approximately 20% of hospital associated health costs.9 The institution of invasive mechanical ventilation seems to be have been an expensive procedure and, indeed, Wagner has drawn attention to this problem stating “there is some level of cost of acute care that is beyond our society’s economic capacity”.10 On the other hand, it has been shown that about 40% of the patients admitted to ICUs, where the daily costs are very high, never receive active intensive care, including mechanical ventilation,11-13 and therefore may be considered ideal candidates for specialised intermediate respiratory care units. In particular, two recent studies have shown that, of patients affected by acute respiratory failure due to pulmonary diseases and admitted to an ICU, only about 40% needed to be invasively ventilated.14 15