Current stage of the intensive care unit structure in Argentina: results from the <i>Sociedad Argentina de Terapia Intensiva</i> self-assessment survey of intensive care units

Gilardino, Ramiro; Gallesio, Antonio; Arias-López, María Pilar; Boada, Nancy; Mandich, Verónica; Sagardia, Judith; Ratto, Maria Elena; Fernández, Ariel

doi:10.5935/0103-507X.20220021-en

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ORIGINAL ARTICLE • Rev. bras. ter. intensiva 34 (2) • Apr-Jun 2022 • https://doi.org/10.5935/0103-507X.20220021-en copy

Current stage of the intensive care unit structure in Argentina: results from the Sociedad Argentina de Terapia Intensiva self-assessment survey of intensive care units

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To describe and compare the structure of Argentinean intensive care units that completed the “self-assessment survey of intensive care units” developed by the Sociedad Argentina de Terapia Intensiva.

Methods:

An observational crosssectional study was conducted using an online voluntary survey through the Sociedad Argentina de Terapia Intensiva member database and other social media postings. Answers received between December 2018 and July 2020 were analyzed. Descriptive statistics and nonparametric tests were used.

Results:

A total of 392 surveys were received, and 244 were considered for the analysis. Seventy-seven percent (187/244) belonged to adult intensive care units, and 23% (57/244) belonged to pediatric intensive care units. The overall completion rate was 76%. The sample included 2,567 ICU beds (adult: 1,981; pediatric: 586). We observed a clear concentration of intensive care units in the Central and Buenos Aires regions of Argentina. The median number of beds was 10 (interquartile range 7 - 15).

The median numbers of multiparameter monitors, mechanical ventilators, and pulse oximeters were 1 per bed with no regional or intensive care unit type differences (adult versus pediatric). Although our sample showed that the pediatric intensive care units had a higher mechanical ventilation/bed ratio than the adult intensive care units, this finding was not linearly correlated.

Conclusion:

Argentina has a notable concentration of critical care beds and better structural complexity in the Buenos Aires and Centro regions for both adult and pediatric intensive care units. In addition, a lack of accurate data reported from the intensive care unit structure and resources was observed. Further improvement opportunities are required to allocate intensive care unit resources at the institutional and regional levels.

Keywords:
Intensive care units/ organization & administration; Intensive care units/classification; Critical care/ organization & administration; Structure of services; Health facilities

Region of Argentina	Population (M)	Demography Area Density (Km²)		Participating units	Total beds	Hospital beds IQR Median (25 - 75)		Beds/100,000 inhabitants	Total CC beds	Median CC beds/hospital	CC beds/ hospital IQR (25 - 75)	Critical care setting Ratio CC/ hospital beds	CC beds/100,000 inhabitants	MV/100,000 inhabitants
Buenos Aires	18,515	307,571	60	107	17,793	165	(65 - 280)	96	2,413	16	(8 - 37)	10%	13	5
Cuyo	2,852	315,226	9	22	3,388	93	(42 - 220)	119	366	12	(6 - 28)	13%	13	5
Center	8,058	377,109	21	41	4,130	100	(46 - 128)	51	716	11	(8 - 24)	11%	9	4
Northeast	3,680	289,699	13	17	2,207	110	(36 - 180)	60	280	14	(8 - 17)	13%	8	3
Northwest	4,911	559,864	9	27	4,113	130	(82 - 202)	84	648	20	(11 - 34)	15%	13	4
Patagonia	2,100	1,752,888	1	30	894	81	(53 - 145)	43	407	12	(8 - 19)	15%	19	10
Total	40,117	3,602 M	11	244	34,740	105	(94 - 125)	81	4,639	13		12%	12	6

	Total (244)	Adult ICU (187)	Pediatric ICU (57)	p value	OR (95%CI)
Geographical distribution
Buenos Aires	107 (43.85)	75 (40.11)	32 (56.14)
Center Cuyo	41 (16.80) 22 (9.02)	35 (18.72) 16 (8.56)	6 (10.53) 6 (10.53)	0.23
Northeast	17 (6.97)	14 (7.49)	3 (5.26)
Northwest	27 (11.07)	24 (12.83)	3 (5.26)
Patagonia	30 (12.29)	23 (12.30)	7 (12.28)
Payer
Public payer^* * Public hospitals or facilities run by the local, state or national government; † Mann-Whitney U test. The results are expressed as the median/(interquartile range).	121 (49.59)	81 (43.32)	40 (70.18)	< 0.001	3.08 (1.57 - 6.21)
University hospital	108 (44.26)	73 (39.04)	35 (61.4)	0.003	2.49 (1.30 - 4.80)
Tertiary center	188 (77.05)	140 (74.87)	48 (84.21)	0.14
Structure†
Beds number	10 (7 - 15)	10 (7 - 16)	8 (6 - 14)	0.15
MM/bed ratio	1 (1 - 1.1)	1 (1 - 1.10)	1 (1 - 1.17)	0.056
MV/bed ratio	1 (0.66 - 1.1)	1 (0.67 - 1.11)	1 (0.87 - 1.17)	0.0044
SO₂/bed ratio	1 (1 - 1.07)	1 (1 - 1)	1 (1 - 1.2)	0.05

	Beds^* * Kruskal-Wallis one-way analysis of variance; † Mann-Whitney U test; ‡ public hospitals or facilities run by the local, state or national government; § private institutions or facilities run by social security, private insurers or for-profit corporations. Results expressed as the median (interquartile range).	p value	MM/bed ratio^* * Kruskal-Wallis one-way analysis of variance; † Mann-Whitney U test; ‡ public hospitals or facilities run by the local, state or national government; § private institutions or facilities run by social security, private insurers or for-profit corporations. Results expressed as the median (interquartile range).	p value	MV/bed ratio^* * Kruskal-Wallis one-way analysis of variance; † Mann-Whitney U test; ‡ public hospitals or facilities run by the local, state or national government; § private institutions or facilities run by social security, private insurers or for-profit corporations. Results expressed as the median (interquartile range).	p value	SO₂/bed ratio^* * Kruskal-Wallis one-way analysis of variance; † Mann-Whitney U test; ‡ public hospitals or facilities run by the local, state or national government; § private institutions or facilities run by social security, private insurers or for-profit corporations. Results expressed as the median (interquartile range).	p value
Geographical distribution
Buenos Aires (107) Center (41) Cuya (22)	11 (7 - 18) 9 (7 - 12.5) 6 (5 - 16)	0.24	1 (1 - 1.14) 1 (1 - 1.08) 1 (1 - 1.17)	0.19	(0.79 - 1.08) 1(0.6 - 1.17) 1.06 (0.83 - 1.2)	0,27	1 (1 - 1.12) 1 (1 - 1) 1 (1 - 1.23)	0.42
Northeast (17)	10 (8 - 14)		1 (0.63 - 1)		1 (0.86 - 1.25)		1 (0.85 - 1)
Northwest (27)	10 (6.5 - 15.5)		1 (1 - 1.12)		0.7 (0.41 - 1.16)		1 (0.8 - 1.08)
Patagonia (30)	9 (6 - 12)		1 (1 - 1.11)		1 (0.66 - 1.04)		1 (0.67 - 1.04)
Payer†
Public‡ (121)	8 (6 - 14)	0.028	1 (1 - 1.17)	0.018	1 (0.9 - 1.17)	< 0.001	1 (1 - 1.15)	0.84
Private§ (123)	10 (7.5 - 16.5)		1 (1 - 1.02)		0.8 (0.62 - 1)		1 (1 - 1)

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[1] Conflicts of interest: None