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Organizational Issues, Structure, and Processes of Care in 257 ICUs in Latin America: A Study From the Latin America
Elisa Estenssoro1, Leyla Alegría, Gastón Murias
11Servicio de Terapia Intensiva, Hospital Interzonal de Agudos General San Martin de La Plata, Buenos Aires, Argentina.2Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.3Clinica Bazterrica and Clinica Santa Isabel, Ciudad Autónoma de Buenos Aires, Argentina.4Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.5Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.6Hospital Español, Montevideo, Uruguay.7ANII, Montevideo, Uruguay.8Unidad de Cuidados Intensivos, Hospital Eugenio Espejo, Quito, Ecuador.9Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador.10Department of Intensive Care Medicine, Fundación Valle del Lili, Universidad ICESI, Cali, Colombia.11Servicio de Terapia Intensiva, Hospital Alejandro Posadas, El Palomar, Buenos Aires, Argentina.12Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, Brazil.13Research Institute HCor, Hospital do Coração, São Paulo, Brazil.14Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Ciudad Autónoma de Buenos Aires, Argentina.15Catedra de Farmacología Aplicada, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Buenos Aires, Argentina.16Hospital Español, ASSE, Montevideo, Uruguay.17Department of Pathophysiology School of Medicine, Universidad de la República, Montevideo, Uruguay.18Área de Investigación Respiratoria, Catedra de Medicina Intensiva, Hospital de Clinicas, UdelaR, Montevideo, Uruguay.19Unidad de Pacientes Críticos, Hospital Clínico Universidad de Chile, Santiago, Chile.20Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY.21St George's University Hospitals NHS Foundation Trust, London, United Kingdom.22Hospital Sirio-Libanes, São Paulo, Brazil.23Emergency Medicine Department, University of Sao Paulo, São Paulo, Brazil.
Objective:
Latin America bears an important burden of critical care disease, yet the information about it is scarce. Our objective was to describe structure, organization, processes of care, and research activities in Latin-American ICUs.
Design:
Web-based survey submitted to ICU directors.
Settings:
ICUs located in nine Latin-American countries.
Subjects:
Individual ICUs.
Interventions:
None.
Measurements And Main Results:
Two hundred fifty-seven of 498 (52%) of submitted surveys responded: 51% from Brazil, 17% Chile, 13% Argentina, 6% Ecuador, 5% Uruguay, 3% Colombia, and 5% between Mexico, Peru, and Paraguay. Seventy-nine percent of participating hospitals had less than 500 beds; most were public (59%) and academic (66%). ICUs were mainly medical-surgical (75%); number of beds was evenly distributed in the entire cohort; 77% had 24/7 intensivists; 46% had a physician-to-patient ratio between 1:4 and 7; and 69% had a nurse-to-patient ratio of 1 ≥ 2.1. The 24/7 presence of other specialists was deficient. Protocols in use averaged 9 ± 3. Brazil (vs the rest) had larger hospitals and ICUs and more quality, surveillance, and prevention committees, but fewer 24/7 intensivists and poorer nurse-to-patient ratio. Although standard monitoring, laboratory, and imaging practices were almost universal, more complex measurements and treatments and portable equipment were scarce after standard working hours, and in public hospitals. Mortality was 17.8%, without differences between countries.
Conclusions:
This multinational study shows major concerns in the delivery of critical care across Latin America, particularly in human resources. Technology was suboptimal, especially in public hospitals. A 24/7 availability of supporting specialists and of key procedures was inadequate. Mortality was high in comparison to high-income countries.
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