Influence of the acquired immunodeficiency syndrome on resource availability in critical care medicine in the coming decade.

Information presented regards the consumption of resources in the management of critically ill patients with the acquired immunodeficiency syndrome (AIDS). Predictions are made about future increases in critical care services for patients with this condition. While increased need will primarily be related to an increased number of patients with AIDS, an expanded need for critical care services is also likely to result from changes in the populations at risk and in the presentation of the syndrome. In particular, the relationship between the AIDS epidemic and tuberculosis is described. The balance between AIDS research costs and the care of patients with the syndrome, as well as the availability of resources, is likely to become less favorable as healthcare reform unfolds. A number of suggestions for coping with this imbalance include efforts to achieve better selection of patients for ICU admission and to employ aggressive therapies and alternative treatments that do not require ICU admission. Creative administrative planning, including the use of case management, therapist-driven protocols, intensified utilization review, regionalization, and expansion of home health services, is discussed. It is necessary for clinicians to demonstrate that therapies result in survival and other substantial benefits. The need to keep legislators informed of new achievements in critical care and a new focus on preventive care are emphasized.