{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:31:35Z","timestamp":1787031095888,"version":"build-2736575974"},"reference-count":30,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2013,4,30]],"date-time":"2013-04-30T00:00:00Z","timestamp":1367280000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The outcomes of patients admitted to a respiratory ICU (RICU) have been evaluated in the past, but no study has considered the influence of location prior to RICU admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We analyzed prospectively collected data from 326 consecutive patients admitted to a 7-bed RICU. The primary end points were survival and severity of morbidity-related complications, evaluated according to the patient's location prior to RICU admission. Three admission pathways were considered: step-down for patients transferred from the ICUs of our hospital; step-up for patients coming from our respiratory wards or other medical wards; and directly for patients coming from the emergency department. The secondary end point was the potential influence of several risk factors for morbidity and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Of the 326 subjects, 92 (28%) died. Overall, subjects admitted in a step-up process had a significantly higher mortality (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) than subjects in the other groups. The mortality rate was 64% for subjects admitted from respiratory ward, 43% for those from medical wards, and 18% for subjects from both ICU and emergency department (respiratory ward vs medical ward\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .04, respiratory ward vs emergency department\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001, respiratory ward vs ICU\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001, medical ward vs emergency department\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001, and medical ward vs ICU\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Subjects admitted from a respiratory ward had a lower albumin level, and Simplified Acute Physiology Score II was significantly higher in subjects following a step-up admission. About 30% of the subjects admitted from a respiratory ward received noninvasive ventilation as a \u201cceiling treatment.\u201d The highest odds ratios related to survival were subject location prior to RICU admission and female sex. Lack of use of noninvasive ventilation, younger age, female sex, higher albumin level, lower Simplified Acute Physiology Score II, higher Barthel score, and absence of chronic heart failure were also statistically associated with a lower risk of death.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>The pathway of admission to a RICU is a determinant of outcome. Patients following a step-up pattern are more likely to die. Other major determinants of survival are age, nutritional status and female sex.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4187\/respcare.02225","type":"journal-article","created":{"date-parts":[[2013,5,1]],"date-time":"2013-05-01T11:29:29Z","timestamp":1367407769000},"page":"2053-2060","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":17,"title":["Influence of the Admission Pattern on the Outcome of Patients Admitted to a Respiratory Intensive Care Unit: Does a Step-Down Admission Differ From a Step-Up One?"],"prefix":"10.1177","volume":"58","author":[{"given":"Ilaria","family":"Valentini","sequence":"first","affiliation":[{"name":"Department of Specialist, Diagnostic and Experimental Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela Maria Grazia","family":"Pacilli","sequence":"additional","affiliation":[{"name":"Department of Specialist, Diagnostic and Experimental Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Carbonara","sequence":"additional","affiliation":[{"name":"Department of Specialist, Diagnostic and Experimental Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Fasano","sequence":"additional","affiliation":[{"name":"Pneumologia e Terapia Intensiva Respiratoria, Azienda Opedaliera Universitaria Sant Orsola-Malpighi, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Vitale","sequence":"additional","affiliation":[{"name":"Department of Specialist, Diagnostic and Experimental Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corrado","family":"Zenesini","sequence":"additional","affiliation":[{"name":"Department of Public Health, Epidemiological Service, Local Health Authority of Bologna, and with Terapia Intensiva Polivalente, Azienda Opedaliera Universitaria Sant Orsola-Malpighi, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita Maria","family":"Melotti","sequence":"additional","affiliation":[{"name":"Department of Public Health, Epidemiological Service, Local Health Authority of Bologna, and with Terapia Intensiva Polivalente, Azienda Opedaliera Universitaria Sant Orsola-Malpighi, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Faenza","sequence":"additional","affiliation":[{"name":"Anestesiologia e Rianimazione, Azienda Opedaliera Universitaria Sant Orsola-Malpighi, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Nava","sequence":"additional","affiliation":[{"name":"Department of Specialist, Diagnostic and Experimental Medicine"},{"name":"Department of Specialist, Diagnostic and Experimental Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2013,4,30]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.02.00058202"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.99.1.205"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s001340051077"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2008.03.002"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000069730.02769.16"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-138-11-200306030-00009"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-0330"},{"issue":"23","key":"e_1_3_2_9_2","first-page":"2526","article-title":"Acute respiratory distress syndrome. 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