Selection of Patients for Admission to the Respiratory Intermediate Care Unit

The respiratory intermediate care units (RICU) usually admit patients with intermediate severity between those managed in a pulmonary ward and those admitted to the intensive care units (ICUs). There are two different assistant circuits, with different purposes: the stepup circuit, whose main aim is to avoid the worsening of acute respiratory failure (ARF), leading eventually to endotracheal intubation, and the step-down, that includes patients with variable degrees of dependence of the mechanical ventilation. The adequacy of admission criteria for individual patients is a key point for the optimal functioning of the RICU. Finally, many patients admitted to the RICU have prior do-not-intubate (DNI) orders, being non-invasive respiratory support (NIRS) their ceiling of therapy. In this setting, it is of utmost importance to have the design of a care planning before admission to the RICU, including how the team should proceed in case of NIRS failure.