Acute lung injury patients one-third less likely to die in 'closed' ...( Patients with acute lung injury (ALI...),Health

Patients with acute lung injury (ALI) are nearly one-third less likely to die if they are treated at ICUs that require board-certified critical care physicians to oversee patient care, as compared to patients treated at ICUs that allow any attending physician to oversee admission and case management.

ALI is an inflammatory disorder of the lung often seen in patients with pneumonia or sepsis. Mortality rates are high -- about 40 percent -- and worsen with age and co-morbidities. Treatment generally involves addressing the underlying condition and providing protective low tidal volume mechanical ventilation and supportive therapy.

ICUs that require patient transfer to an intensivist run team or mandate a co-attending intensivist are associated with reduced mortality in patients with ALI, wrote Miriam Treggiari, M.D., M.P.H., of the Harborview Medical Center at the University of Washington, who led the study that appears in the first issue for October of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

The study is the first to use data from a population-based prospective cohort of patients to evaluate outcomes of different ICU organizational models. As part of the National Institutes of Health funded King County Lung Injury Project, all patients in Seattle area ICUs receiving mechanical ventilation were screened for ALI, between April 1999 and July 2000. Detailed data on co-morbidities, length of hospital stay and discharge information was collected. Questionnaires were sent to both the medical directors and/or attending physicians of the ICUs and the nurse managers to assess the organizational model and structure of the ICUs. The final study group included 1,075 patients in 22 ICUs across 16 hospitals.

Two-thirds of the patients were treated at closed ICUsunits that require cases to be managed by board-certified critical care physicians or that mandate intensivists
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