Organisation and Management of Intensive Care : A Prospective Study in 12 European Countries PDF

Edited by D. Reis Miranda, D.W. Ryan, Wilmar Schaufeli, V. Fidler

Part of the Update in Intensive Care and Emergency Medicine series

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Description

From the viewpoint of a health economist, the intensive care unit (leU) is a particularly fascinating phenomenon.

It is the epitome of "high-tech" medicine and frequently portrayed as the place where life-saving miracles are routinely wrought.

But the popular imagina- tion is also caught up in the darker side, when agonizing decisions have to be made to avoid futile and inhuman continuation of expen- sive treatments.

My analytical interests led me to approach these issues by asking what the evidence tells us about which leu activities are very bene- ficial in relationship to their costs and which are not.

This quickly translates into a slightly different question, namely, which patients are most appropriately treated in an leu and which not.

Unfor- tunately, it is very hard to answer these questions because it has pro- ved very difficult to investigate these issues in the manner which is now regarded as the "gold standard:' namely by conducting rando- mized clinical trials or alternative courses of action.

I think this is a pity, and I am not at all convinced that it would be unethical to do so in many cases, because there is wide variation in practice and ge- nuine doubt as to which practices are best -the two conditions that need to be fulfilled before such a trial is justifiable.