Department of Anesthesiology, Columbia University, New York, New York 10032, USA.
Curr Opin Crit Care. 2012 Dec;18(6):700-6. doi: 10.1097/MCC.0b013e32835914d5.
Interest in international comparisons of critical illness is growing, but the utility of these studies is questionable. This review examines the challenges of international comparisons and highlights areas in which international data provide information relevant to clinical practice and resource allocation.
International comparisons of ICU resources demonstrate that definitions of critical illness and ICU beds vary due to differences in ability to provide organ support and variable staffing. Despite these limitations, recent international data provide key information to understand the pros and cons of different availability of ICU beds on patient flow and outcomes, and also highlight the need to ensure long-term follow-up due to heterogeneity in discharge practices for critically ill patients. With increasing emphasis on curbing costs of healthcare, systems that deliver lower cost care provide data on alternative options, such as regionalization, flexible allocation of beds, and bed rationing.
Differences in provision of critical care can be leveraged to inform decisions on allocation of ICU beds, improve interpretation of clinical outcomes, and assess ways to decrease costs of care. International definitions of key components of critical care are needed to facilitate research and ensure rigorous comparisons.
人们对危重病的国际比较越来越感兴趣，但这些研究的实用性值得怀疑。本综述探讨了国际比较面临的挑战，并强调了国际数据在哪些方面为临床实践和资源配置提供了相关信息。
国际比较表明，由于提供器官支持的能力不同和人员配置的差异，危重病和 ICU 床位的定义有所不同。尽管存在这些局限性，但最近的国际数据为了解 ICU 床位的不同可及性对患者流动和结果的利弊提供了关键信息，并强调需要确保长期随访，因为危重病患者的出院实践存在异质性。随着对控制医疗保健成本的重视，提供低成本护理的系统提供了有关替代方案的数据，例如区域化、床位灵活分配和床位配给。
危重病护理提供方面的差异可用于为 ICU 床位的分配提供信息，改善对临床结果的解释，并评估降低护理成本的方法。需要制定危重病护理关键组成部分的国际定义，以促进研究并确保进行严格的比较。
