The ICU Milieu: An Evaluation of the Allocation of a Limited Resource

Abstract

During its two decades of development, the practice of intensive care has produced some dramatic patient survivals. Reports of early development document mortality rate decreases from more than 90 per cent to 20 to 50 per cent. Costs of providing such care have increased as dramatically, with disproportionate amounts of resources (capital equipment, personnel, other hospital services) often being expended compared with relatively small numbers of survivors. Nevertheless, hospitals continue to expand intensive care units.

Decisions about further expansion and continued administration of intensive care to all critically ill patients should depend on the following considerations: proven effectiveness of intensive care on reducing mortality rates, expansion of the content of ethical considerations, reevaluation of traditional medical attitudes, the attitudes and wishes of the patient and his family, financial considerations, and the practical demands of overcrowded and understaffed units.

Preliminary studies reported here indicate that the number and impact of individual system complications may be quantified. This cumulative impact index, in conjunction with sound and continuing clinical judgment, may permit identification of groups of patients who are most likely to benefit from intensive care and those for whom intensive care is likely to achieve only an extremely low probability of survival.