From intermediate intensive unit to home care.

The procedure of discharging the chronically ill respiratory patient from an intermediate intensive care unit (IICU) is always difficult and requires multidisciplinary intervention. A complete clinical and functional evaluation is necessary during the period of hospitalization to determine the weaning possibilities and the respiratory performance of the patient in care. In-hospital management should also be able to produce an accurate plan for home care, especially in those subjects for whom ventilatory support cannot be denied. Appropriate instruction for the care-givers involved must be provided. Funding requirements should be carefully evaluated. Four hundred and sixty five chronically, critically ill respiratory patients were admitted to our cardiopulmonary IICU (34% of the total patients admitted) coming from intensive care units (ICUs) or other departments. The death rate was 6%. Six patients were transferred to an ICU due to urgent necessity. Three hundred and thirty eight subjects were mechanically-ventilated (115 invasively), and 23 were finally admitted to a long-term home-care programme. Nowadays, the respiratory IICU can be considered a new hospital ward, where appropriate monitoring can be performed and accurate evaluation for discharge should be planned. Knowledge of worldwide experience is necessary to establish the best way to discharge patients from a respiratory IICU and to eventually recommend them for a home-care programme.