Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, Philadelphia, USA.
Curr Opin Crit Care. 2011 Dec;17(6):648-57. doi: 10.1097/MCC.0b013e32834c7a53.
Increasing demand for critical care, with limited potential for comparable expansion of supply, may strain the abilities of ICUs to provide high-quality care in an equitable fashion. Efforts to counter the untoward consequences for the quality and ethics of critical care delivery are limited by the absence of a specific and validated metric of ICU capacity strain.
This manuscript presents a conceptual framework for ICU capacity strain, considers what data elements may contribute to it, and suggests methods for determining the optimal metric. Next, it outlines the range of potential consequences of increased capacity strain, in terms of both the quality and ethics of care delivered. Finally, consideration is given to how untoward consequences of ICU capacity strain might be mitigated through better understanding of what makes some ICUs better able than others to withstand temporal fluctuations in the demand for their services.
Development of an appropriately accurate and parsimonious measure of ICU capacity strain may augment the precision of future critical care outcomes research by reducing unexplained variance attributable to temporal fluctuations in ICU-level factors; elucidate organizational characteristics that make some ICUs better able to withstand high-capacity strain without substantive degradations in quality; and enhance the transparency of critical care rationing while helping to improve its equity and efficiency, thereby promoting the ethics of this inevitable practice.
对重症监护的需求不断增加，而供应的潜在增长有限，这可能会使 ICU 提供高质量、公平护理的能力受到压力。由于缺乏重症监护供应能力紧张的具体和经过验证的衡量标准，因此，应对重症监护服务提供的质量和道德方面的不利后果的努力受到限制。
本文提出了一个 ICU 容量紧张的概念框架，考虑了哪些数据元素可能对其有贡献，并提出了确定最佳衡量标准的方法。接下来，它概述了增加容量紧张的潜在后果，包括护理质量和道德方面。最后，考虑通过更好地了解是什么使某些 ICU 比其他 ICU 更有能力承受其服务需求的时间波动，从而减轻 ICU 容量紧张的不利后果。
开发一种适当准确和简洁的 ICU 容量紧张衡量标准，可以通过减少由于 ICU 水平因素的时间波动而导致的无法解释的差异，来提高未来重症监护结果研究的精确性；阐明使某些 ICU 能够在不实质性降低质量的情况下更好地承受高容量紧张的组织特征；提高重症监护配给的透明度，同时有助于提高其公平性和效率，从而促进这一不可避免的实践的道德性。
