(1267) A Review of Upgrades to the Medical Intensive Care Unit for Acute Respiratory Failure

Introduction: On average, 5 million patients are admitted to an ICU level of care each year. Of the five principal diagnoses seen in the ICU, acute respiratory failure remains the most common, accounting for 54% of cases each year. Previous studies have shown a 30-35% all-cause mortality rate for respiratory failure in the ICU. The goal of this study was to identify outcomes of patients upgraded to the Medical ICU (MICU) from lower levels of inpatient care, for respiratory failure compared to available national data. We hypothesized that upgraded patients would have worse outcomes when compared to all ICU cases of respiratory failure.

Methods: We conducted a retrospective review of rapid response and code blue events initiated for patients with respiratory failure between June 2022 to July 2023 at a tertiary academic medical center. Direct admissions to the MICU and upgrades to non-medical ICUs were excluded. Admitting diagnosis, code status, length of stay and level of care at admission were reviewed. Patients were stratified into groups based on oxygen delivery systems used while in the MICU. Lastly, patient outcomes at time of discharge were identified.

Results: There were 192 total upgrades to the MICU, and 78 events (39%) were due to acute respiratory failure. Of these, there was a 48% all-cause mortality rate. Of the patients who died, 53% required an escalation through all 3 forms of oxygen delivery: HFNC, BiPAP or mechanical ventilation (MV).16% of deceased patients required HFNC and BiPAP alone. 29% of patients who died required HFNC, then MV. 91% of patients in this cohort were confirmed full code on admission, however after continued goals of care conversations in the MICU almost half of these patients transitioned to comfort care measures.

Conclusions: The mortality rate of patients who were escalated through lower levels of care before upgrading to the MICU was significantly higher than the all-cause mortality rate amongst all ICU patients with acute respiratory failure. Patients who were escalated through all three modes of oxygen delivery had a higher mortality rate compared to patients who received two modes of oxygen delivery. Patients who received HFNC then BIPAP alone had the lowest mortality rate, while patients who were escalated from HFNC to MV had the highest rate of discharges home.