Organizational Issues, Structure, and Processes of Care in 257 ICUs in Latin America: A Study From the Latin America Intensive Care Network

Organizational Issues, Structure, and Processes of Care in 257 ICUs in Latin America: A Study From the Latin America Intensive Care Network

Author Estenssoro, Elisa Google Scholar
Alegria, Leyla Google Scholar
Murias, Gaston Google Scholar
Friedman, Gilberto Google Scholar
Castro, Ricardo Google Scholar
Vaeza, Nicolas Nin Google Scholar
Loudet, Cecilia Google Scholar
Bruhn, Alejandro Google Scholar
Jibaja, Manuel Google Scholar
Ospina-Tascon, Gustavo Google Scholar
Rios, Fernando Google Scholar
Machado, Flavia R. Autor UNIFESP Google Scholar
Cavalcanti, Alexandre Biasi Google Scholar
Dubin, Arnaldo Google Scholar
Hurtado, F. Javier Google Scholar
Briva, Arturo Google Scholar
Romero, Carlos Google Scholar
Bugedo, Guillermo Google Scholar
Bakker, Jan Google Scholar
Cecconi, Maurizio Google Scholar
Azevedo, Luciano Autor UNIFESP Google Scholar
Hernandez, Glenn Google Scholar
Abstract 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.
Keywords health services research
intensive care unit staffing
Latin America
nurse staffing
physician-to-patient ratio
Language English
Date 2017
Published in Critical Care Medicine. Philadelphia, v. 45, n. 8, p. 1325-1336, 2017.
ISSN 0090-3493 (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent 1325-1336
Origin http://dx.doi.org/10.1097/CCM.0000000000002413
Access rights Closed access
Type Article
Web of Science ID WOS:000405469600031
URI http://repositorio.unifesp.br/handle/11600/51491

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