Intensive care services; a crisis of increasing expressed demand

Critical care services appear to face increasing demand. To attempt to identify factors which may predispose to such increases in demand, the patients and their treatment were reviewed. The patients' ages, referring specialty and their risk of hospital mortality were recorded on admission. The durations of respiratory and renal support (if required) were recorded. Pulmonary artery catheter insertion and the number of vasoactive drugs infused were also noted. During the study, the capacity of the intensive care unit was initially increased by one bed (from six to seven) and later by a six-bedded high-dependency unit. This capacity increase was not matched by a proportionate decrease in occupancy. The patients' mean ages increased by 1 year per year. The number of patients referred from general surgery consistently increased. The proportion of patients receiving vasoactive drugs and pulmonary artery catheters declined as did the duration of respiratory and renal support.