Respiratory Failure Deadlier When It Happens in Hospitals

Simple reasoning would lead us to believe that there’s no better place to get sick than in the hospital, but when it comes to respiratory failure, the data tells us otherwise.

“Essentially, patients who develop respiratory failure in the hospital did significantly worse than those patients that had respiratory failure diagnosed at time of admission,” said James P. Lamberti, MD, pulmonary critical care physician, Inova Fairfax Hospital, Falls Church, Virginia.

According to Lamberti’s analysis of a large Medicare database, nearly one third of the 110,000 patients who develop respiratory failure in hospitals died in the hospital, and another 15% died in the 30 days following hospitalization.

“What we found was that it wasn’t lung patients necessarily [who were at greater risk of death], it was patients with underlying diseases and multiple diseases. We found congestive heart failure, atrial fibrillation, and acute kidney injury occurred in these patients. I think we may not be thinking of respiratory failure early enough in patients that don’t have an underlying lung diagnosis like COPD,” Lamberti said.

Physicians need to evaluate this group of patients to see if they’re making diagnoses too late, and if there are monitoring techniques that can be used to identify at-risk patients before they develop respiratory failure, Lamberti explained.

“I think we’re not making the diagnosis of respiratory failure soon enough,” he said. “We know this from other disease states. For example, sepsis [treatment] has really been revolutionized over the last 10 years, mostly because we are diagnosing it earlier and doing things sooner.”

Results similar to the findings in Lamberti’s respiratory failure analysis have been identified in relation to acute myocardial infarctions as well.

“If you come to the hospital and are suffering a heart attack, your risk of dying is about 4%,” Lamberti said. “If that heart attack occurs after you’ve been admitted to the hospital, your mortality is 40%. What we’re hoping is that a similar analysis of the patients that develop respiratory failure after hospital admission will lead to a change in how we take care of these patients.”

Lamberti’s study looked at Medicare patients who are over the age of 65, with certain exceptions for patients with disabilities.

According to the US Department of Health and Human Services, Agency for Healthcare Research and Quality, respiratory compromise is the third most rapidly increasing hospital inpatient cost in the United States, with $7.8 billion spent on respiratory compromise in US hospitals in 2007. The condition increases patient mortality rates by over 30% and hospital and ICU stays by almost 50%.

“I think what we need to do as a community is to start to understand these patients better and not just accept what is occurring as natural. I think we can do a better job of defining this group and making earlier interventions,” Lamberti said.