Friday, November 16, 2007

Friday November 16, 2007
Intensivists do make difference

Here is another study endorsing the positive effect of intensivists on ICU mortality. This study was performed to examine the association of closed vs open models with patient mortality with ALI (acute lung injury).

Closed ICUs
are defined as units that required patient transfer to or mandatory patient comanagement by an intensivist. Open ICUs as those relying on other organizational models.


13 ICUs were designated closed and 11 open.


Results:


  • Closed ICUs had reduced hospital mortality (adjusted odds ratio, 0.68; 95% confidence interval, 0.53, 0.89; P = 0.004).
  • Consultation by a pulmonologist in open ICUs was not associated with improved mortality (adjusted odds ratio, 0.94; 95% confidence interval, 0.74, 1.20; P = 0.62).
  • The use of low tidal volume in patients with ALI was different between closed and open ICUs. In open ICUs had triple the risk of receiving injurious (>12 ml/kg PBW) tidal volumes, whereas patients in closed ICUs were almost three times more likely to receive lung-protective tidal volumes (6.5 ml/kg PBW) on Day 3 of mechanical ventilation after ALI onset.

Conclusions: Patients with ALI cared for in a closed-model ICU have reduced mortality. These data support recommendations to implement structured intensive care in the United States.



Reference: click to get abstract/article

1. Effect of Intensive Care Unit Organizational Model and Structure on Outcomes in Patients with Acute Lung Injury - American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 685-690, (2007)

No comments: