Patients treated by critical-care physicians during their stays in intensive-care units were generally sicker and had higher hospital mortality rates than people who did not receive critical-care management, a new study reports.
Patients experienced more respiratory system disease, infections and traumas and received more interventions, drugs and sedation under critical-care doctors, according to the study published in the June 3 issue of the Annals of Internal Medicine. Researchers said the findings were unexpected because earlier studies have reported patients saw improved outcomes when treated by critical-care physicians. Despite adjustment for severity of illness, we cannot demonstrate any survival benefits with management by critical-care physicians, the researchers wrote in their report.
Using data from 101,832 patients taken from the national ICU database Project Impact, researchers studied facilities in which patients received critical-care management for the entire length of stay and those where patients received no such care. Hospitals that managed 95% or more of their patients with critical-care doctors tended to be larger hospitals with academic affiliations, according to the report. The odds of dying in the hospital were slightly higher for patients in these facilities, as well, the researchers said.
While other studies have shown improved outcomes following critical-care management, this study suggests that greater use of various treatments does not benefit some patients, the researchers said in the report. Although we believe that critical-care physicians are trained and expertly skilled, perhaps some routine critical-care practices and procedures may not be beneficial or cumulative use of more interventions may take a negative toll, they wrote. -- by Jean DerGurahian
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