Rafael Fernández1, Susana Altaba, Lluis Cabre, Victoria Lacueva, Antonio Santos, Jose-Felipe Solsona, Jose-Manuel Añon, Rosa-Maria Catalan, Maria-Jose Gutierrez, Ramon Fernandez-Cid, Vicente Gomez-Tello, Emilio Curiel, Enrique Fernandez-Mondejar, Joan-Carles Oliva, Ana Isabel Tizon, Javier Gonzalez, Pablo Monedero, Manuela Garcia Sanchez, M Victoria de la Torre, Pedro Ibañez, Fernando Frutos, Frutos Del Nogal, M Jesus Gomez, Alfredo Marcos, Paula Vera, Jose Manuel Serrano, Isabel Umaran, Andres Carrillo, M-Jose Lopez-Pueyo, Pedro Rascado, Begoña Balerdi, Borja Suberviola, Gonzalo Hernandez. 1. * Director, Intensive Care Unit, Fundació Althaia, Manresa, CIBERES, Universitat Internacional de Catalunya, Barcelona, Spain. † Intensive Care Unit, Hospital G.U., Castello, Castello, Spain. ‡ Intensive Care Unit, Hospital de Barcelona SCIAS, Barcelona, Spain. § Intensive Care Unit, Hospital de Sagunt, Sagunt, Spain. ‖ Intensive Care Unit, C.Hosp.U. de Santiago de Compostela, Santiago de Compostela, Spain. # Intensive Care Unit, Hospital del Mar, Barcelona, Spain. ** Intensive Care Unit, Hospital Virgen de la Luz, Cuenca, Spain. †† Intensive Care Unit, C. Hosp. de Vic, Vic, Spain. ‡‡ Intensive Care Unit, Hospital San Agustin, Aviles, Spain. §§ Intensive Care Unit, Hospital Mateu Orfila, Menorca, Spain. ‖‖ Intensive Care Unit, Hospital Moncloa, Madrid, Spain. ## Intensive Care Unit, Hospital U. Carlos Haya (Hospital Civil), Malaga, Spain. *** Intensive Care Unit, Hospital Virgen de las Nieves, Granada, Spain. ††† Statistical Department, Fundació Parc Taulí, Corporació Sanitaria Universitaria Parc Taulí, Universidad Autònoma de Barcelona, Sabadell, Spain. ‡‡‡ Members of the Sabadell Score Group are listed in the appendix. Hospital Xeral Cies, Vigo, Spain Hospital de Salamanca, Salamanca, Spain Clinica Universitaria de Navarra, Navarra, Spain Hospital Virgen Macarena, Sevilla, Spain Hospital Virgen de la Victoria, Malaga, Spain Hospital Son Llatzer, Mallorca, Spain Hospital Universitario de Getafe, Getafe, Spain, CIBER Enfermedades Respiratorias Hospital Severo Ochoa, Leganes, Spain Hospital Reina Sofia, Murcia, Spain Hospital Virgen de la Concha, Zamora, Spain Hospital Sant Joan de Reus, Reus, Spain Hospital Reina Sofia, Cordoba, Spain Hospital de Cruces, Baracaldo, Spain Hospital Morales Messeguer, Murcia, Spain Hospital General Yague, Burgos, Spain Hospital Universitario de A Coruña, A Coruña, Spain Hospital La Fe, Valencia, Spain Hospital Marques de Valdecilla, Santander, Spain Hospital Infanta Sofia, San Sebastian de los R
Abstract
BACKGROUND: Recent studies have found an association between increased volume and increased intensive care unit (ICU) survival; however, this association might not hold true in ICUs with permanent intensivist coverage. Our objective was to determine whether ICU volume correlates with survival in the Spanish healthcare system. METHODS: Post hoc analysis of a prospective study of all patients admitted to 29 ICUs during 3 months. At ICU discharge, the authors recorded demographic variables, severity score, and specific ICU treatments. Follow-up variables included ICU readmission and hospital mortality. Statistics include logistic multivariate analyses for hospital mortality according to quartiles of volume of patients. RESULTS: The authors studied 4,001 patients with a mean predicted risk of death of 23% (range at hospital level: 14-46%). Observed hospital mortality was 19% (range at hospital level: 11-35%), resulting in a standardized mortality ratio of 0.81 (range: 0.5-1.3). Among the 1,923 patients needing mechanical ventilation, the predicted risk of death was 32% (14-60%) and observed hospital mortality was 30% (12-61%), resulting in a standardized mortality ratio of 0.96 (0.5-1.7). The authors found no correlation between standardized mortality ratio and ICU volume in the entire population or in mechanically ventilated patients. Only mechanically ventilated patients in very low-volume ICUs had slightly worse outcome. CONCLUSION: In the currently studied healthcare system characterized by 24/7 intensivist coverage, the authors found wide variability in outcome among ICUs even after adjusting for severity of illness but no relationship between ICU volume and outcome. Only mechanically ventilated patients in very low-volume centers had slightly worse outcomes.
BACKGROUND: Recent studies have found an association between increased volume and increased intensive care unit (ICU) survival; however, this association might not hold true in ICUs with permanent intensivist coverage. Our objective was to determine whether ICU volume correlates with survival in the Spanish healthcare system. METHODS: Post hoc analysis of a prospective study of all patients admitted to 29 ICUs during 3 months. At ICU discharge, the authors recorded demographic variables, severity score, and specific ICU treatments. Follow-up variables included ICU readmission and hospital mortality. Statistics include logistic multivariate analyses for hospital mortality according to quartiles of volume of patients. RESULTS: The authors studied 4,001 patients with a mean predicted risk of death of 23% (range at hospital level: 14-46%). Observed hospital mortality was 19% (range at hospital level: 11-35%), resulting in a standardized mortality ratio of 0.81 (range: 0.5-1.3). Among the 1,923 patients needing mechanical ventilation, the predicted risk of death was 32% (14-60%) and observed hospital mortality was 30% (12-61%), resulting in a standardized mortality ratio of 0.96 (0.5-1.7). The authors found no correlation between standardized mortality ratio and ICU volume in the entire population or in mechanically ventilated patients. Only mechanically ventilated patients in very low-volume ICUs had slightly worse outcome. CONCLUSION: In the currently studied healthcare system characterized by 24/7 intensivist coverage, the authors found wide variability in outcome among ICUs even after adjusting for severity of illness but no relationship between ICU volume and outcome. Only mechanically ventilated patients in very low-volume centers had slightly worse outcomes.
Authors: Georg Heinrich Kluge; Sylvia Brinkman; Giel van Berkel; Johannes van der Hoeven; Crétien Jacobs; Yvonne E M Snel; John P W Vogelaar; Nicolette F de Keizer; Emiel S Boon Journal: Intensive Care Med Date: 2015-01-20 Impact factor: 17.440
Authors: Maurizia Capuzzo; Carlo Volta; Tania Tassinati; Rui Moreno; Andreas Valentin; Bertrand Guidet; Gaetano Iapichino; Claude Martin; Thomas Perneger; Christophe Combescure; Antoine Poncet; Andrew Rhodes Journal: Crit Care Date: 2014-10-09 Impact factor: 9.097