B104-05 Intermediate Versus Intensive Care for Patients With Moderate-Severe Acute Respiratory Failure

Abstract Rationale Patients with acute respiratory failure (ARF) requiring non-invasive ventilation (NIV) are often admitted to either intensive care units (ICUs) or intermediate care (IMC) settings, which can both provide this advanced respiratory support. However, little is known about which setting may be optimal for patients who do not yet require the full spectrum of ICU care. Methods In a retrospective cohort study of two, IMC capable, US health systems participating in the Common Longitudinal ICU data Format (CLIF) consortium from 2018-2024, we included adults receiving NIV for 6 hours in the ED and subsequently admitted to either an ICU or IMC setting. We excluded patients who received invasive mechanical ventilation (IMV), vasopressors, had an SpO2/FiO2 150, PaCO2 60 with pH 7.25, Glasgow Coma Scale (GCS) 9, or who were “comfort measures only.” The primary outcome was in-hospital death or discharge to hospice. The secondary outcome was hospital length of stay (LOS) penalized for death or discharge to hospice. Logistic regression was used for the death/hospice outcome and linear regression for length of stay (log10 scale, penalized for death/hospice), each with a random intercept for the hospital and adjustment for age, sex, BMI, Elixhauser comorbidity index, non-respiratory SOFA, SpO2/FiO2 ratio, pH, year, and season. Site-specific estimates were pooled using random-effects meta-analysis with inverse-variance weighting (DerSimonian-Laird method). Results Of 3,507 qualifying ED encounters across two IMC-capable health systems, 1550 (44%) were admitted to an ICU and 1957 (56%) to an IMC. In adjusted analyses, IMC admission was associated with similar odds of in-hospital death or discharge to hospice compared with admission to an ICU (odds ratio 0.81; 95% confidence interval: 0.57-1.14). Compared to the ICU, mean LOS was similar for IMC (regression coefficient, -0.03; 95% confidence interval, -0.14-0.08) (Figure 1). Conclusion Among ED patients with ARF requiring NIV, outcomes were similar in patients admitted to ICUs or IMCs. These findings suggest that, in current practice, clinicians are successfully identifying patients appropriate for non-ICU management, highlighting opportunities to refine triage and use of intermediate care. This abstract is funded by: John’s Hopkins School of Medicine Dean’s Year of Research Funding, National Institutes of Health, National Heart, Lung, and Blood Institute K23HL169743