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UK and US level of intensive care patient 'illness' widely different

  • 4 Comments

Patients who receive intensive care services are very different in the US than in the UK, according to a study, published in the American Journal of Respiratory and Critical Care Medicine.

 Researchers analysed excluding surgical admissions, patients younger than 16 years, and readmissions to ICU during the same hospital stay.

They found the degree of illness of the patients prior to admission was strikingly different.

Patients admitted to the ICU in the UK were sicker patients who had been in the hospital longer, and many more were mechanically ventilated. 

 

  • 4 Comments

Readers' comments (4)

  • George Kuchanny

    There is a problem in some British ITU's where a 'more intervention is better' still reigns. Invasive procedures are routinlely performed without a risk/benefit assessment.
    For instance a patient with a head injury gets a CVP line inserted into the carotid artery. Cerebral perfusion is compromised for the benefit of central veinous pressure readings.
    And so it is with positive pressure ventilation. An oxgen delivery cannula may be appropriate but a patient is sedated and intubated with little gain and massively increased risk of an airway damaging adverse event. We clearly need to tighen up on assessment of invasive interventions and stop routinely applying them before balancing risk.

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  • George why would you put a central venous catheter in to an artery? please be careful.

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  • Latterlife Midwife

    "Patients admitted to the ICU in the UK were sicker patients who had been in the hospital longer, and many more were mechanically ventilated. "

    George, I'm not sure your point is relevant to the article's, as presented.

    Maybe the difference here (UK) is that, with fewer resources/less money available, patients who might have benefited from earlier admission to ICU did not get there until their condition was far more desperate?

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  • George Kuchanny

    James,
    Precisely! Subclavian route is the only one to consider for head injury yet I have seen the carotid route to the heart used. Unwise. As are quite a few other invasive procedures which are unfortunately viewed as routine.

    Latterlife Midwife,
    Yes. Comment needed expansion to tie in relevance. The US model is extremely variable. To illustrate, a city hospital mainly caring for an uninsured local population will be spending far less than us per capita. A University Hospital in a wealthy state will be spending more. However the States overall has more ITU beds per head of population than we do. Another confounding factor in a straight comparison is the variance in trauma due to direct violence. Many more gunshot wounds than us is just a part of it. America is more violent and their vehicle accidents (for reasons lost to me) result in higher mortality.

    The odd thing here is that the Americans honestly think that the British are exposed to extraodinarily high knife crime injuries. This is not actually borne out in any published figure.

    So in sum, after taking all factors into consideration, I would say that it is not a matter of funding as per se. It is a cultural difference in what we and the Americans deem to be a safe, or indeed wothwhile intervention.

    A Canadian study would be more interesting to use as a comparison with us in the UK because, in my view Canadians take their evidence based probable outcomes very seriously indeed when deciding on an intervention and care plan.

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