PMID- 31277148
OWN - NLM
STAT- MEDLINE
DCOM- 20190711
LR  - 20221005
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 98
IP  - 27
DP  - 2019 Jul
TI  - Mortality rate and other clinical features observed in Open vs closed format 
      intensive care units: A systematic review and meta-analysis.
PG  - e16261
LID - 10.1097/MD.0000000000016261 [doi]
LID - e16261
AB  - BACKGROUND: Nowadays most of the intensive care units (ICUs) operate as a closed 
      format in comparison to an open format. The new concept of a closed ICU is where 
      patients are admitted under the full responsibility of a trained intensivist, 
      whereas an open ICU is where patients are admitted under the care of another 
      attending physician and intensivists are just available for consultation. In this 
      analysis, we aimed to systematically compare mortality rate and other clinical 
      features observed in open vs closed ICU formats. METHODS: Biomedical and 
      pharmacological bibliographic database Excerpta Medica database (EMBASE), Medical 
      Literature Analysis and Retrieval System Online (MEDLINE), the Cochrane Central 
      and www.ClinicalTrials.gov were searched for required English publications. 
      Mortality, the frequency of patients requiring mechanical ventilation, central 
      line, arterial line and pulmonary arterial catheter were assessed respectively. 
      Statistical analysis was carried out by the RevMan software. Odds ratios (OR) 
      with 95% confidence intervals (CIs) were used to represent the data following 
      analysis. RESULTS: Five studies with a total number of 6160 participants enrolled 
      between years 1992 to 2007 were included. Results of this analysis showed that 
      mortality rate was significantly higher in the open format ICU (OR: 1.31, 95% CI: 
      1.17-1.48; P = .00001) (using a fixed effect model) and (OR: 1.31, 95% CI: 
      1.09-1.59; P = .005) (using a random effect model). Closed format ICUs were 
      associated with significantly higher number of patients that required central 
      line (OR: 0.56, 95% CI: 0.34-0.92; P = .02). Patients requiring mechanical 
      ventilation (OR: 1.08, 95% CI: 0.65-1.78; P = .77), patients requiring arterial 
      line (OR: 1.05, 95% CI: 0.49-2.29; P = .89) and patients requiring pulmonary 
      arterial catheter (OR: 0.86, 95% CI: 0.40-1.87; P = .71) were similar in the open 
      vs the closed setting. CONCLUSION: This analysis showed that mortality rate was 
      significantly higher in an open as compared to a closed format ICU. However, the 
      frequency of patients requiring mechanical ventilation, arterial line and 
      pulmonary arterial catheter was similarly observed. Larger trials are expected to 
      further confirm those hypotheses.
FAU - Yang, Qian
AU  - Yang Q
AD  - Department of Intensive Care Unit (ICU), Jingzhou Central Hospital, The Second 
      Clinical Medical College, Yangtze University, Jingzhou, Hubei, PR China.
FAU - Du, Jin Long
AU  - Du JL
FAU - Shao, Feng
AU  - Shao F
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - IM
MH  - Critical Illness/*mortality
MH  - Global Health
MH  - Hospital Mortality/trends
MH  - Humans
MH  - Intensive Care Units/*statistics & numerical data
MH  - Length of Stay/trends
MH  - *Organizational Innovation
MH  - Survival Rate/trends
PMC - PMC6635169
COIS- The authors have no funding and conflicts of interest to disclose.
EDAT- 2019/07/07 06:00
MHDA- 2019/07/12 06:00
PMCR- 2019/07/05
CRDT- 2019/07/07 06:00
PHST- 2019/07/07 06:00 [entrez]
PHST- 2019/07/07 06:00 [pubmed]
PHST- 2019/07/12 06:00 [medline]
PHST- 2019/07/05 00:00 [pmc-release]
AID - 00005792-201907050-00063 [pii]
AID - MD-D-18-07365 [pii]
AID - 10.1097/MD.0000000000016261 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2019 Jul;98(27):e16261. doi: 10.1097/MD.0000000000016261.