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Acute lung injury patients one-third less likely to die in 'closed' model ICUs
Date:9/28/2007

to co-manage on all patients. The remaining third received care at open ICUs, where cases could be managed by any attending physicians with admitting privileges, and pulmonary consultations were optional. According to the American College of Chest Physicians, only 25 percent of ICUs nationwide follow the closed model.

There were no significant differences in the degree of illness between patients who were cared for in closed versus open ICUs as measured by Acute Physiological and Chronic Health Evaluation III (APACHE III) scores, but patients at closed ICUs were younger and more likely to be male.

Patients cared for in a closed ICU had statistically significantly lower mortality than patients cared for in open ICUs, the researchers reported. Interestingly, the effect remained significant after adjusting for a number of variables in the analysis. While 77 percent of patients in closed ICUs were seen by a pulmonary consultant, consults alone did not have a significant effect on mortality. Similarly, adjusting for nurse-to-patient ratio and hospital volume of mechanically ventilated patients had no effect on mortality. Of patients treated in open ICUs, 45 percent died; in closed ICUs there was 35 percent mortality.

The investigators noted that because of the small sample size of hospitals and the date of the data collection, it would be difficult to extrapolate their results to a general trend among ICUs in the United States. Noting that the use of low tidal volume mechanical ventilation differed between closed and open ICUs, the researchers remarked that other unrecognized differences in patient care could exist, but that their results add support for the positive effect of a closed ICU model on patient outcome.

These findings add to the evidence of the important role of intensivist staffing in caring for critically ill patients, and support the recommendations to implement closed-model ICUs in the United States, said Dr. Treggia
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Contact: Keely Savoie
ksavoie@thoracic.org
212-315-8620
American Thoracic Society
Source:Eurekalert

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