Reorganizing the respiratory high dependency unit for pandemics

Area of Science:

• Critical Care Medicine
• Respiratory Medicine
• Health Services Management

Background:

• Respiratory high dependency units (RHDUs) serve as an intermediate care level between intensive care units (ICUs) and hospital wards.
• Historically, RHDUs managed hypercapnic respiratory failure but adapted to hypoxemic respiratory failure, including during the COVID-19 pandemic.
• The COVID-19 pandemic highlighted the need for RHDUs to manage patient flow, reducing ICU admissions and facilitating early ICU discharges.

Purpose of the Study:

• To review the dual role of RHDUs in managing respiratory failure, particularly during the COVID-19 pandemic.
• To propose adaptations and optimizations for RHDUs to meet emergent healthcare needs.
• To emphasize the role of noninvasive respiratory therapies in preventing intubation and ICU admission.

Main Methods:

• A literature search was conducted on MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials.
• Keywords included COVID-19, RHDU, Respiratory Intermediate care Unit, ARDS, NIV, HFNC, prone position, and monitoring.
• The review synthesizes European expert perspectives on RHDU utilization and optimization.

Main Results:

• RHDUs have a dual purpose: decreasing ICU admissions and enabling earlier ICU discharges.
• Despite their role, the surge of COVID-19 patients often exceeded hospital capacity and forecasts.
• Spontaneous creation and expansion of RHDUs occurred during the pandemic to manage patient load.

Conclusions:

• Reorganization and optimization of care are necessary for severe COVID-19 patients, minimizing ICU admissions.
• Adapting RHDUs is essential to meet pandemic-driven healthcare demands.
• Expert application of noninvasive respiratory therapies in RHDUs can prevent intubation and reduce ICU dependency.