Significance of the Respiratory Rate in Emergency Medicine

The Prognostic Significance of Respiratory Rate in Patients With Pneumonia: A Retrospective Analysis of Data From 705 928 Hospitalized Patients in Germany From 2010–2012 by PD Dr. med. Richard Strauß, Prof. Dr. med. Santiago Ewig, Dr. med. Klaus Richter, Dr. rer. nat. Thomas König, PD Dr. med. Günther Heller, Prof. Dr. med. Torsten T. Bauer in issue 29–30/2014

The authors of the study show that the respiratory rate is an independent risk marker for hospital mortality in community acquired pneumonia (CAP). We wish to add that the respiratory rate is an important risk marker for the purposes of sensitively identifying emergency patients at vital risk (1). This idea is only insufficiently implemented in clinical practice in Germany and Switzerland: for this reason, we introduced a five step triage system (the emergency severity index, ESI) in the emergency departments at Nuremberg and Basel university medical centers, so as to identify early on critically ill patients by using the obligatory measuring of the respiratory rate, among others.

Furthermore, an interprofessional CAP treatment concept was introduced in Nuremberg, in order to facilitate the recommended treatment within the recommended intervals (local adaptation of CAP guidelines, introduction of checklists, further medical educational events, interactive workshops, process analyses, feedback sessions). The implementation of management bundles has significantly improved the quality of care for affected patients and has reduced in-hospital mortality of CAP patients by 21% (1). On the basis of our experiences we suggest further standardization in medical emergencies that require time critical action.

In the future it would be helpful to establish diagnostic instruments to facilitate the measuring of the respiratory rate in the initial diagnostic evaluation. Appropriate equipment is available in the form of devices that measure oxygen saturation or—by using a video analysis system—the respiratory rate (3). These devices will, however, still have to be validated in the setting of emergency and acute medicine, and their diagnostic importance will need to be evaluated in relevant studies. Measuring the respiratory rate is absolutely crucial in any emergency patient.

DOI: 10.3238/arztebl.2015.0173b

Dr. med. Marcus Hortmann

Universitäts-Herzzentrum Freiburg,

Klinik für Kardiologie und Angiologie I

PD Dr. med. Christian H. Nickel

Prof. Dr. med. Roland Bingisser
Interdisziplinäre Notfallstation, Universitätsspital Basel

Prof. Dr. med. Michael Christ

Klinik für Notfallmedizin und Internistische Intensivmedizin

Paracelsus Medizinische Privatuniversität Nürnberg

Conflict of interest statement

The authors declare that no conflict of interest exists .

References

1. Hortmann M, Heppner HJ, Popp S, Lad T, Christ M: Reduction of mortality in community-acquired pneumonia after implementing standardized care bundles in the emergency department. Eur J Emerg Med 2014; 21: 429–35.

2. Grossmann FF, Nickel CH, Christ M, Schneider K, Spirig R, Bingisser R: Transporting clinical tools to new settings: cultural adaptation and validation of the emergency severity index in german. Ann Emerg Med 2011; 57: 257–64.

3. Addison PS, Watson JN, Mestek ML, Ochs JP, Uribe AA, Bergese SD: Pulse oximetry-derived respiratory rate in general care floor patients. J Clin Monit Comput 2014; epub ahead of print].

4. Strauß R, Ewig S, Richter K, König T, Heller G, Bauer TT: The prognostic significance of respiratory rate in patients with pneumonia—a retrospective analysis of data from 705 928 hospitalized patients in Germany from 2010–2012. Dtsch Arztebl Int 2014; 111: 503–8.