Acute Crit Care.  2025 May;40(2):171-185. 10.4266/acc.004728.

Trends and management of acute respiratory failure in hospitalized patients: a multicenter retrospective study in South Korea

• Yang WJ
• Choi YJ
• Chung KS
• Choi JS
• Jung BM
• Cho JH

• KMID: 2569427
• DOI: http://doi.org/10.4266/acc.004728

Abstract

Background
Acute respiratory failure (ARF) is the leading cause of hospitalization and is associated with in-hospital mortality. This study aimed to elucidate the epidemiology and clinical outcomes of ARF.
Methods
We retrospectively screened patients admitted to three hospitals in South Korea between January 2018 and December 2022. We included individuals aged 18 years, diagnosed with either type 1 ARF (arterial oxygen partial pressure [PaO2] <60 mm Hg) or type 2 ARF (arterial carbon dioxide partial pressure (PaCO2) >45 mm Hg) with a pH of <7.35, or diagnosed with the combined-type ARF.
Results
Among the 768,700 hospitalized patients, 33,278 (4.3%) developed ARF. The most common cause of ARF was sepsis (15,757 patients, 47.3%), and the most frequent comorbidity was malignancy (15,403 patients, 43.6%). Among ARF patients, 15,671 (47.1%) required intensive care unit transfer, while 8,980 (27.0%) experienced in-hospital mortality. Over 5 years, the proportion of ARF patients aged 80 years and older has shown a consistent annual increase (coefficient, 0.085 and Ptrend <0.001). Concurrently, the in-hospital mortality rate exhibited an upward trend, increasing from 25.5% in 2018 to 29.3% in 2022 (coefficient, 1.017 and Ptrend<0.001). Among the respiratory support methods used for patients with ARF over the 5-year period, high-flow nasal cannula usage steadily increased (coefficient, 4.137 and Ptrend<0.001), whereas the use of invasive mechanical ventilation declined (coefficient, –0.983 and Ptrend<0.001).
Conclusions
ARF frequency and in-hospital mortality rates are increasing, driven by various etiologies. Despite these trends, research on the epidemiology and individualized treatments for older patients is limited, highlighting the need for nationwide prospective multicenter studies.

Keyword

epidemiology; intensive care units; Korea; mortality; respiratory failure; respiratory insufficiency

Reference

1. Choi YJ, Cho JH. Current status of treatment of acute respiratory failure in Korea. J Korean Med Assoc. 2022; 65:124–9. DOI: 10.5124/jkma.2022.65.3.124.

2. Vincent JL, Sakr Y, Ranieri VM. Epidemiology and outcome of acute respiratory failure in intensive care unit patients. Crit Care Med. 2003; 31(4 Suppl):S296–9. DOI: 10.1097/01.ccm.0000057906.89552.8f. PMID: 12682455.

3. Cartin-Ceba R, Kojicic M, Li G, Kor DJ, Poulose J, Herasevich V, et al. Epidemiology of critical care syndromes, organ failures, and life-support interventions in a suburban US community. Chest. 2011; 140:1447–55. DOI: 10.1378/chest.11-1197. PMID: 21998258.

4. Kempker JA, Abril MK, Chen Y, Kramer MR, Waller LA, Martin GS. The epidemiology of respiratory failure in the United States 2002-2017: a serial cross-sectional study. Crit Care Explor. 2020; 2:e0128. DOI: 10.1097/cce.0000000000000128. PMID: 32695994.

5. Scala R, Heunks L. Highlights in acute respiratory failure. Eur Respir Rev. 2018; 27:180008. DOI: 10.1183/16000617.0008-2018. PMID: 29592866.

6. Narendra DK, Hess DR, Sessler CN, Belete HM, Guntupalli KK, Khusid F, et al. Update in management of severe hypoxemic respiratory failure. Chest. 2017; 152:867–79. DOI: 10.1016/j.chest.2017.06.039. PMID: 28716645.

7. See KC, Sahagun J, Taculod J. Patient characteristics and outcomes associated with adherence to the low PEEP/FIO₂ table for acute respiratory distress syndrome. Sci Rep. 2021; 11:14619. DOI: 10.1038/s41598-021-94081-z. PMID: 34272453.

8. Qaseem A, Etxeandia-Ikobaltzeta I, Fitterman N, Williams JW Jr, Kansagara D; Clinical Guidelines Committee of the American College of Physicians, et al. Appropriate use of high-flow nasal oxygen in hospitalized patients for initial or postextubation management of acute respiratory failure: a clinical guideline from the American College of Physicians. Ann Intern Med. 2021; 174:977–84. DOI: 10.7326/m20-7533. PMID: 33900796.

9. Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017; 50:1602426. DOI: 10.1183/13993003.02426-2016. PMID: 28860265.

10. See KC. Approach to acute respiratory failure for frontline clinicians. Singapore Med J. 2022; 63:740–5. DOI: 10.4103/singaporemedj.smj-2022-002. PMID: 36573658.

11. Glenardi G, Chriestya F, Oetoro BJ, Mangkuliguna G, Natalia N. Comparison of high-flow nasal oxygen therapy and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis. Acute Crit Care. 2022; 37:71–83. DOI: 10.4266/acc.2021.01326. PMID: 35279978.

12. Park S. Treatment of acute respiratory failure: high-flow nasal cannula. J Korean Med Assoc. 2022; 65:131–43. DOI: 10.5124/jkma.2022.65.3.131.

13. Koh SO, Kim JR. Complications during ventilatory support in patients with acute respiratory failure. Yonsei Med J. 1994; 35:142–8. DOI: 10.3349/ymj.1994.35.2.142. PMID: 8091790.

14. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40:373–83. DOI: 10.1016/0021-9681(87)90171-8. PMID: 3558716.

15. Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med. 1998; 26:1793–800. DOI: 10.1097/00003246-199811000-00016. PMID: 9824069.

16. Shashikumar SP, Stanley MD, Sadiq I, Li Q, Holder A, Clifford GD, et al. Early sepsis detection in critical care patients using multiscale blood pressure and heart rate dynamics. J Electrocardiol. 2017; 50:739–40. DOI: 10.1016/j.jelectrocard.2017.08.013. PMID: 28916175.

17. Shashikumar SP, Li Q, Clifford GD, Nemati S. Multiscale network representation of physiological time series for early prediction of sepsis. Physiol Meas. 2017; 38:2235–48. DOI: 10.1088/1361-6579/aa9772. PMID: 29091053.

18. Fleuren LM, Klausch TL, Zwager CL, Schoonmade LJ, Guo T, Roggeveen LF, et al. Machine learning for the prediction of sepsis: a systematic review and meta-analysis of diagnostic test accuracy. Intensive Care Med. 2020; 46:383–400. DOI: 10.1007/s00134-019-05872-y. PMID: 31965266.

19. Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, et al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012; 38:1573–82. DOI: 10.1007/s00134-012-2682-1. PMID: 22926653.

20. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016; 315:801–10. DOI: 10.1001/jama.2016.0287. PMID: 26903338.

21. Brown SM, Duggal A, Hou PC, Tidswell M, Khan A, Exline M, et al. Nonlinear imputation of PaO₂/FIO₂ from SpO₂/FIO₂ among mechanically ventilated patients in the ICU: a prospective, observational study. Crit Care Med. 2017; 45:1317–24. DOI: 10.1097/CCM.0000000000002514. PMID: 28538439.

22. Baek MS, Chung CR, Kim HJ, Cho WH, Cho YJ, Park S, et al. Age is major factor for predicting survival in patients with acute respiratory failure on extracorporeal membrane oxygenation: a Korean multicenter study. J Thorac Dis. 2018; 10:1406–17. DOI: 10.21037/jtd.2018.03.71. PMID: 29707290.

23. Brown R, McKelvey MC, Ryan S, Creane S, Linden D, Kidney JC, et al. The impact of aging in acute respiratory distress syndrome: a clinical and mechanistic overview. Front Med (Lausanne). 2020; 7:589553. DOI: 10.3389/fmed.2020.589553. PMID: 33195353.

24. Polok K, Fronczek J, Guidet B, Artigas A, De Lange DW, Fjølner J, et al. Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic. Ann Intensive Care. 2023; 13:82. DOI: 10.1186/s13613-023-01173-2. PMID: 37698708.

25. Rodriguez Lima DR, Anzueta Duarte JH, Rubio Ramos C, Otálora González L, Pinilla Rojas DI, Gómez Cortés LA, et al. Risk factors for in-hospital mortality in older patients with acute respiratory distress syndrome due to COVID-19: a retrospective cohort study. BMC Geriatr. 2024; 24:878. DOI: 10.1186/s12877-024-05411-5. PMID: 39462358.

26. Rhee C, Klompas M. Sepsis trends: increasing incidence and decreasing mortality, or changing denominator? J Thorac Dis. 2020; 12(Suppl 1):S89–100. DOI: 10.21037/jtd.2019.12.51. PMID: 32148931.

27. Herrán-Monge R, Muriel-Bombín A, García-García MM, Merino-García PA, Cítores-González R, Fernández-Ratero JA, et al. Mortality reduction and long-term compliance with surviving sepsis campaign: a nationwide multicenter study. Shock. 2016; 45:598–606. DOI: 10.1097/SHK.0000000000000555. PMID: 27186683.

28. Lorencio Cárdenas C, Yébenes JC, Vela E, Clèries M, Sirvent JM, Fuster-Bertolín C, et al. Trends in mortality in septic patients according to the different organ failure during 15 years. Crit Care. 2022; 26:302. DOI: 10.1186/s13054-022-04176-w. PMID: 36192781.

29. Bauer M, Gerlach H, Vogelmann T, Preissing F, Stiefel J, Adam D. Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019: results from a systematic review and meta-analysis. Crit Care. 2020; 24:239. DOI: 10.1186/s13054-020-02950-2. PMID: 32430052.

30. Prest J, Nguyen T, Rajah T, Prest AB, Sathananthan M, Jeganathan N. Sepsis-related mortality rates and trends based on site of infection. Crit Care Explor. 2022; 4:e0775. DOI: 10.1097/cce.0000000000000775. PMID: 36248320.

31. Cundrle I Jr, Olson LJ, Johnson BD. Pulmonary limitations in heart failure. Clin Chest Med. 2019; 40:439–48. DOI: 10.1016/j.ccm.2019.02.010. PMID: 31078220.

32. Lee CJ, Lee H, Yoon M, Chun KH, Kong MG, Jung MH, et al. Heart failure statistics 2024 update: a report from the Korean Society of Heart Failure. Int J Heart Fail. 2024; 6:56–69. DOI: 10.36628/ijhf.2024.0010. PMID: 38694933.

33. Park S. High-flow nasal cannula for respiratory failure in adult patients. Acute Crit Care. 2021; 36:275–85. DOI: 10.4266/acc.2021.01571. PMID: 35263823.

34. Giamarellos-Bourboulis EJ, Siampanos A, Bolanou A, Doulou S, Kakavoulis N, Tsiakos K, et al. Clarithromycin for early anti-inflammatory responses in community-acquired pneumonia in Greece (ACCESS): a randomised, double-blind, placebo-controlled trial. Lancet Respir Med. 2024; 12:294–304. DOI: 10.1016/s2213-2600(23)00412-5. PMID: 38184008.

35. Matthay MA, Zemans RL, Zimmerman GA, Arabi YM, Beitler JR, Mercat A, et al. Acute respiratory distress syndrome. Nat Rev Dis Primers. 2019; 5:18. DOI: 10.1038/s41572-019-0069-0. PMID: 30872586.

36. Shi T, Feng L. Blood biomarkers associated with acute type II respiratory failure in COPD: a meta-analysis. Clin Respir J. 2022; 16:75–83. DOI: 10.1111/crj.13464. PMID: 35001553.