RCI Launches Study of Unplanned Intubations to Better Understand Respiratory Compromise

Duke Study Press Release 09/19/18 — Study Aims to Assess Demographic, Clinical Characteristics and Care Practices That Increase Patients’ Risk for Potentially Deadly Condition  

DURHAM, N.C. — The Respiratory Compromise Institute today announced the initiation of a clinical study aimed at better understanding the prevalence, risk factors and pathways for unplanned airway intubations as a measure of respiratory compromise. Respiratory compromise is a deterioration of respiratory function that poses a high risk of life-threatening respiratory failure, the second leading avoidable patient safety issue.1 General care floor patients with respiratory compromise are 29 times more likely to die.2

Led by Neil MacIntyre, MD, FCCP, Professor of Medicine (Pulmonary, Allergy and Critical Care Medicine) at Duke University School of Medicine, and supported by the Respiratory Compromise Institute (RCI), the study will draw on the electronic health records of patient encounters at DUHS’ three hospitals: Duke University Hospital (DUH), Duke Regional Hospital (DRH) and Duke Raleigh Hospital (DRAH). 

The study researchers hope to assess demographic, clinical and care practice characteristics that impact the risk profile of patients 18 years or older with unplanned intubations 24 hours or more after admission or surgery on general medical and surgical floors. The source population will include patients at DUH, DRH and DRAH admitted from January 1, 2014 to December 31, 2017. DUH is a large, 957-acute care bed academic facility, providing tertiary referral care for North Carolina; DRH is a 369-bed community-based facility attending to underserved populations in Durham County, North Carolina; and DRAH is a 186-bed facility serving Raleigh, North Carolina.  

“Our study uses unplanned intubations as an end result of progressive respiratory compromise, which may be difficult to detect early and have a high incidence in minimally monitored care settings, such as medical and surgical floors,” said Dr. MacIntyre. “If we can identify which patient characteristics and aspects of clinical practice present the greatest risk, then healthcare providers will be better positioned to prevent or mitigate respiratory compromise. Furthermore, we believe that, by creating a data and analytics framework that can be adapted to other institutions, our study will serve as a model for future research.”

Demographic data that investigators will be examining to assess patient risk for respiratory compromise include: age, race/ethnicity, sex, smoking and alcohol status. Researchers will also be looking at vital signs, laboratory data and clinical picture along with pre-existing medical conditions, such as diabetes, liver disease, cancer and other factors that can increase patients’ risk. The impact of commonly prescribed medications, including benzodiazepines and sleep aids, will also be assessed. 

“Electronic health records enable us to amass large quantities of data on patients, which can and should be utilized to understand patient risk for a variety of health conditions that arise during in-hospital patient care,” said Phillip Porte, Executive Director of RCI. “Innovative research like the kind being conducted by Dr. MacIntyre will help us continue to deepen our understanding of and hopefully better recognize and prevent respiratory compromise, which has been the aim of the Respiratory Compromise Institute since its founding.”  

The study’s expected completion date is end of 2018. Dr. MacIntyre’s co-investigators include: Armando Bedoya, MD, MMCi, Nrupen Bhavsar, PhD, MPH, and Benjamin Goldstein, PhD, MPH.  

About Respiratory Compromise
Respiratory compromise, which includes respiratory distress, insufficiency, failure and arrest, can occur across numerous clinical scenarios. For example, respiratory compromise may appear post-operatively or may be drug-induced by the delivery of a sedative, opioid, or analgesic to patients who were not properly assessed or properly monitored.

According to the U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality, respiratory failure is the fourth most common patient safety event.3 In patient respiratory compromise costs are expected to surpass $37 billion by 2019.4 Respiratory compromise increases patient mortality rates by over 30 percent and hospital and ICU stays by almost 50 percent. RCI defines respiratory compromise as a state in which there is a high likelihood of decompensation into respiratory insufficiency, respiratory failure or death that could be prevented or mitigated through specific interventions (enhanced monitoring and/or therapies).

About Respiratory Compromise Institute
The Respiratory Compromise Institute brings together a broad-based coalition of organizations, companies, and individuals dedicated to reducing—and eventually eliminating—preventable adverse events and deaths due to respiratory compromise.


  1. Healthgrades website, “Quality Matters: Tackle the Top 3 Patient Safety Issues.” 
  2. Kelley SD, SA, Agarwal S, Parikh N, Erslon M, Morris P. Respiratory insufficiency, arrest and failure among medical patients on the general care floor. Crit Care Med. 2012; 40(12):764.
  3. 2015 National Healthcare Quality and Disparities Report and 5th Anniversary Update on the National Quality Strategy Content Last Reviewed May 2016. Rockville, MD: Agency for Healthcare Research and Quality; April 2016.
  4. Agarwal SJ, Erslon MG, Bloom JD. Projected incidence and cost of respiratory failure, insufficiency and arrest in Medicare population, 2019. Abstract presented at Academy Health Congress, June 2011.