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Abstract
The shortage of intensive care unit (ICU) resources, including equipment and supplies for renal replacement therapy (RRT), is a critical problem in several countries. This study aimed to assess hospital mortality and associated factors in patients treated in public hospitals of the Federal District, Brazil, who requested admission to ICU with renal replacement therapy support (ICU-RRT) in court. Retrospective cohort study that included 883 adult patients treated in public hospitals of the Federal District who requested ICU-RRT admission in court from January 2017 to December 2018. ICU-RRT was denied to 407 patients, which increased mortality (OR 3.33, 95% CI 2.39–4.56, p ≪ 0.01), especially in patients with priority level I/II (OR 1.02, 95% CI 1.01–1.04, p ≪ 0.01). Of the requests made in court, 450 were filed by patients with priority levels III/IV, and 44.7% of these were admitted to ICU-RRT. In admitted patients, priority level III priority level I/II was associated with a low mortality (OR 0.47, 95% CI 0.32–0.69, p < 0.01), and not. The admission of patients classified as priority levels III/IV to ICU-RRT considerably jeopardized the admission of patients with priority levels I/II to these settings. The results found open new avenues for organizing public policies and improving ICU-RRT triage.
Highlights
The shortage of intensive care unit (ICU) resources, including equipment and supplies for renal replacement therapy (RRT), is a critical problem in several countries
This finding shows that the shortage of ICU with renal replacement therapy support (ICU-RRT) beds is a critical problem in Brazil since before the COVID-19 pandemic reached the country (February 26, 2020)[33]
Patients without ICU-RRT admission showed a significantly higher mortality than ICU-RRT admitted patients. This fact is crucial in patients without ICU-RRT admission classified as priority level I, who had a considerably higher mortality compared to those with ICURRT admission, showing an odds ratio for hospital mortality about 31 times higher
Summary
The shortage of intensive care unit (ICU) resources, including equipment and supplies for renal replacement therapy (RRT), is a critical problem in several countries. This study aimed to assess hospital mortality and associated factors in patients treated in public hospitals of the Federal District, Brazil, who requested admission to ICU with renal replacement therapy support (ICU-RRT) in court. The shortage of intensive care unit (ICU) resources, including equipment and supplies for renal replacement therapy (RRT), is a critical problem in several countries[1–8] even before the COVID-19 pandemic, drawing attention to the limited capacity of resources in ICU settings worldwide[9–17]. In a health system with limited resources to meet the increased demand for ICU and RRT, ICU admission regulation centers were created in each Brazilian state to control and optimize the flow of ICU admissions in public hospitals.
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