SEPAR Position Paper on Infrastructure, Technology, Staffing, Quality Standards, and Management of Intermediate Respiratory Care Units in Spain.

Intermediate Respiratory Care Units (IRCUs) play an increasingly important role in the management of patients with acute or acute-on-chronic respiratory failure who require more advanced monitoring and respiratory support than can be provided on conventional hospital wards but do not require admission to an Intensive Care Unit (ICU). Their development has been driven by the widespread adoption of noninvasive ventilation, high-flow nasal cannula (HFNC) therapy, and continuous respiratory monitoring, and their strategic value was clearly demonstrated during the COVID-19 pandemic. This position paper from the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) provides evidence-informed recommendations regarding the infrastructure, technology, staffing, organization, and quality standards necessary for the optimal functioning of IRCUs in Spain. A multidisciplinary panel of experts developed consensus-based guidance drawing on available scientific evidence and clinical experience, addressing architectural design, technological resources, professional roles, training pathways, clinical care models, and quality indicators. IRCUs have emerged as a key component in the management of acute and chronic respiratory failure, contributing to improved clinical outcomes and more efficient use of critical care resources. This document highlights the importance of standardized admission criteria, structured care processes, multidisciplinary coordination, and continuous performance evaluation using validated indicators to support the consolidation of IRCUs as high-value, sustainable components of modern respiratory care systems.