Receiving Life Support Research Articles

Frailty, Outcomes, Recovery and Care Steps of Critically Ill Patients (FORECAST): a prospective, multi-centre, cohort study

PurposeFrailty is common in critically ill patients but the timing and optimal method of frailty ascertainment, trajectory and relationship with care processes remain uncertain. We sought to elucidate the trajectory and care processes of frailty in critically ill patients as measured by the Clinical Frailty Scale (CFS) and Frailty Index (FI).MethodsThis is a multi-centre prospective cohort study enrolling patients ≥ 50 years old receiving life support > 24 h. Frailty severity was assessed with a CFS, and a FI based on the elements of a comprehensive geriatric assessment (CGA) at intensive care unit (ICU) admission, hospital discharge and 6 months. For the primary outcome of frailty prevalence, it was a priori dichotomously defined as a CFS ≥ 5 or FI ≥ 0.2. Processes of care, adverse events were collected during ICU and ward stays while outcomes were determined for ICU, hospital, and 6 months.ResultsIn 687 patients, whose age (mean ± standard deviation) was 68.8 ± 9.2 years, frailty prevalence was higher when measured with the FI (CFS, FI %): ICU admission (29.8, 44.8), hospital discharge (54.6, 67.9), 6 months (34.1, 42.6). Compared to ICU admission, aggregate frailty severity increased to hospital discharge but improved by 6 months; individually, CFS and FI were higher in 45.3% and 50.6% patients, respectively at 6 months. Compared to hospital discharge, 18.7% (CFS) and 20% (FI) were higher at 6 months. Mortality was higher in frail patients. Processes of care and adverse events were similar except for worse ICU/ward mobility and more frequent delirium in frail patients.ConclusionsFrailty severity was dynamic, can be measured during recovery from critical illness using the CFS and FI which were both associated with worse outcomes. Although the CFS is a global measure, a CGA FI based may have advantages of being able to measure frailty levels, identify deficits, and potential targets for intervention.

Development of Prone Position Ventilation Device and Study on the Application Effect of Combined Life Support Technology in Critically Ill Patients.

This study aims to evaluate a novel prone position ventilation device designed to enhance patient safety, improve comfort, and reduce adverse events, facilitating prolonged tolerance in critically ill patients. A randomized controlled trial was conducted on 60 critically ill patients from January 2020 to June 2023. Of which, one self-discharged during treatment and another was terminated due to decreased oxygenation, leaving an effective sample of 58 patients. Patients were allocated to either a control group receiving traditional prone positioning aids (ordinary sponge pads and pillows) or an intervention group using a newly developed adjustable prone positioning device. A subset of patients in each group also received life support technologies such as extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). We assessed prone position ventilation tolerance, oxygen saturation increments postintervention, duration of prone positioning, CRRT filter lifespan, and the incidence of adverse events. The intervention group exhibited significantly longer average tolerance to prone positioning (16.6 hours vs. 8.3 hours, P < 0.001 with a difference of 8.3 (4.4, 12.2) hours), higher increases in oxygen saturation postventilation (9% vs. 6%, P < 0.001 with a difference of 3.0 (1.5, 4.5)), and reduced time required for medical staff to position patients (11.7 min vs. 21.8 min, P < 0.001 with a difference of -10.1 (-11.9, -8.3)). Adverse events, including catheter displacement or blockage, facial edema, pressure injuries, and vomiting or aspiration, were markedly lower in the intervention group, with statistical significance (P < 0.05). In patients receiving combined life support, the intervention group demonstrated improved catheter blood drainage and extended CRRT filter longevity. The newly developed adjustable prone ventilation device significantly improves tolerance to prone positioning, enhances oxygenation, and minimizes adverse events in critically ill patients, thereby also facilitating the effective application of life support technologies.

2081. COVID-19 mRNA Vaccine Effectiveness against Hospitalizations among U.S. Children and Adolescents During Omicron Variant Predominance

Abstract Background SARS-CoV-2 Omicron variants have increased vaccine-induced immune evasion and their emergence coincided with waning COVID-19 vaccine effectiveness (VE). The duration of immunity from the primary series and VE of booster doses against pediatric COVID-19 (Omicron)-associated hospitalizations has not been characterized in the United States. Methods Using a case-control design, we examined VE against laboratory-confirmed COVID-19-associated hospitalizations, enrolling case-patients hospitalized for COVID-19 and SARS-CoV-2 test-negative controls with COVID-like illness from 31 hospitals in 23 states. VE was estimated through multivariable logistic regression by comparing the odds of antecedent primary series or booster COVID-19 mRNA vaccination within and beyond 60 days prior to hospitalization. Results were analyzed by age group (5–11 and 12–18 years) among patients admitted December 19, 2021–March 30, 2023. Results We enrolled 1,242 case-patients (972 [78%] of whom were unvaccinated, 164 [13%] of whom received life support, and 11 of whom died) and 1,309 controls. Among children aged 5-18 years, VE of 2 mRNA doses (complete primary series) against pediatric COVID-19 hospitalization was 64% (95% confidence interval [CI]: 44–76%) at 14-60 days after dose 2 (median time since dose 2, 38 days); VE waned to 38% (95% CI: 23–50%) at ≥60 days (median time since vaccination, 213 days). Within 60 days of a monovalent booster dose, VE was 52% (95% CI: -3–77%); among children aged 5-11 years, VE of a bivalent booster dose was 79% (95% CI: 25-94%). Among case-patients who required life support or died, 122/164 (74%) were unvaccinated and only 3 (2%) had received a bivalent booster dose.Figure 1.Vaccine effectiveness against COVID-19-related hospitalizations, by age group, vaccine dose, and time since last dose. VE estimates were only plotted if confidence interval width was &amp;lt;200. Adjusted models included ≥1 underlying medical condition (yes/no), age in years, census region, biweekly date of hospital admission, and social vulnerability index (SVI) score. Sex and race/ethnicity were tested as confounders in the full model but were dropped for absence of evidence of confounding.Table 1.Critical outcomes among enrolled COVID-19 case-patients ages 5-18 years, by vaccine dose and time since last vaccine dose. Abbreviations: ICU, intensive care unit; ECMO, extracorporeal membrane oxygenation Conclusion COVID-19 mRNA vaccination reduced the likelihood of pediatric COVID-19 hospitalization by &amp;gt;60%; VE waned but remained protective, even at a median of 213 days after dose 2. Although not reaching statistical significance due to limited power, monovalent boosters appeared to temporarily restore protection, and bivalent booster doses among 5–11-year-olds were nearly 80% protective against hospitalization. Nearly three quarters of children requiring life support or who died were unvaccinated. Disclosures Regina Simeone, PhD, Pfizer: Stocks/Bonds Natasha B. Halasa, MD, MPH, Merck: Grant/Research Support|Quidell: Grant/Research Support|Quidell: donation of kits|Sanofi: Grant/Research Support|Sanofi: vaccine support

ANTERIOR THALAMIC ISCHAEMIC STROKE SECONDARY TO CARDIOPULMONARY ARREST.

Ischaemic anterior thalamic lesions are rare and can present with disturbances of behaviour and memory. We describe a patient with post-cardiac arrest thalamic stroke. A 63-year-old man presented with cardiac arrest, was resuscitated after receiving life support, and showed no lesions on computed tomography. Three days later, he presented with short-term memory disturbance and disorientation, with a de novo anterior thalamic lesion. The anterior thalamic nucleus, supplied by the posterior communicating artery, is part of the Papez circuit and has a role in modulating behaviour and memory. An anterior thalamic syndrome presents with no sensory-motor deficits. Anterior thalamic stroke is a rare condition and can present with disturbances of short-term memory and behaviour; it usually does not include any motor or sensory deficits.Thalamic stroke can occur due to global hypoxia, such as during cardiopulmonary arrest.

Training practices in neonatal and paediatric life support: A survey among healthcare professionals working in paediatrics

AimTo evaluate neonatal and paediatric life support training practices across Europe. MethodsWe conducted a descriptive study. Paediatric residents, general paediatricians, and subspecialists were surveyed to assess how paediatric basic and advanced life support (PBLS/PALS) and neonatal life support (NLS) are practically arranged and utilised throughout Europe. A mini-Delphi approach was used for survey development. Eligible professionals in general and university hospitals received a web link to the survey. Results498 respondents from 16 countries were included. A large majority of responses came from the Netherlands (n=393) and Belgium (n=42). Therefore, analysis was based on these responses. PBLS was more frequently offered than PALS and NLS, though not to all professionals caring for children. For PBLS, PALS, and NLS, official recertification varied between 35–75%. Approximately 80–90% had read the latest guidelines, at least partially. Sixty to seventy percent felt capable of instant PALS, 75–90% considered themselves able to perform PBLS and NLS instantly. Not reading the guidelines and less confidence about instant resuscitation seemed to occur more often in the lower and higher age/experience groups compared to the intermediate age/experience groups. A quarter of the respondents <30 years did not feel prepared for instant PALS. General paediatricians appeared to feel most capable of instant resuscitation. General and university hospitals had rather similar training practices and facilities. Manikins were predominantly low-fidelity, especially in general hospitals. Barriers to course participation were high costs, lack of time, the non-compulsory status, remote location, and unavailability of courses. ConclusionAlthough most paediatric professionals receive life support training, guideline reading, recertification, training utilisation, and resuscitation preparedness require improvement. Barriers to course participation should be addressed.

Should a Patient Who Is Pregnant and Brain Dead Receive Life Support, Despite Objection From Her Appointed Surrogate?

This article considers whether and when a physician is obligated to offer life support to the point of fetal viability to a patient who is brain dead and pregnant. Lack of ethical, legal, and clinical consensus about best practice in managing this kind of case; a poor clinical evidence base; and the fact that offering life support violates the patient's autonomy and human dignity, as expressed in her advance directive, are sources of ethical, legal, and clinical complexity analyzed here.

Operationalizing needs-focused palliative care for older adults in intensive care units: Design of and rationale for the PCplanner randomized clinical trial

IntroductionThe number of older adults who receive life support in an intensive care unit (ICU), now 2 million per year, is increasing while survival remains unchanged. Because the quality of ICU-based palliative care is highly variable, we developed a mobile app intervention that integrates into the electronic health records (EHR) system called PCplanner (Palliative Care planner) with the goal of improving collaborative primary and specialist palliative care delivery in ICU settings. ObjectiveTo describe the methods of a randomized clinical trial (RCT) being conducted to compare PCplanner vs. usual care. Methods and analysisThe goal of this two-arm, parallel group mixed methods RCT is to determine the clinical impact of the PCplanner intervention on outcomes of interest to patients, family members, clinicians, and policymakers over a 3-month follow up period. The primary outcome is change in unmet palliative care needs measured by the NEST instrument between baseline and 1 week post-randomization. Secondary outcomes include goal concordance of care, patient-centeredness of care, and quality of communication at 1 week post-randomization; length of stay; as well as symptoms of depression, anxiety, and post-traumatic stress disorder at 3 months post-randomization. We will use general linear models for repeated measures to compare outcomes across the main effects and interactions of the factors. We hypothesize that compared to usual care, PCplanner will have a greater impact on the quality of ICU-based palliative care delivery across domains of core palliative care needs, psychological distress, patient-centeredness, and healthcare resource utilization.

Outcomes for Ectopia Cordis

To utilize a large multicenter neonatal cohort to describe survival and clinical outcomes of very low birth weight (VLBW) or preterm infants with ectopia cordis. Data were prospectively collected on 2 211 262 infants (born 2000-2017) from 845 US centers. Both VLBW (401-1500g or 22-29weeks of gestation) and non-VLBW (>1500g and >29weeks) infants had diagnoses or anatomic descriptors consistent with ectopia cordis and/or pentalogy of Cantrell. The primary outcome was neonatal survival, defined as hospital discharge or initial length of stay of ≥12months. In total, 180 infants had ectopia cordis, 135 (76%) with findings of pentalogy of Cantrell. VLBW infants comprised 52% of the population. VLBW mortality was 96% with 79% dying within 12hours, compared with 59% and 36%, respectively, for non-VLBW. One-third of VLBW infants received life support compared with 65% of non-VLBW. Surgery was reported for 34% of VLBW and 68% of non-VLBW infants. Congenital heart disease was reported in 8% of VLBW and 36% of non-VLBW, with conotruncal abnormalities most common. Survival exceeded 50% for infants >2500g and >37weeks of gestation. Survival of VLBW infants with ectopia cordis was poor and substantially worse compared with non-VLBW, with notable discrepancies in resuscitative efforts and surgical interventions. Although gestational age and weight strongly influence current survival, more detailed information regarding the severity of cardiac and noncardiac abnormalities is required to fully determine prognosis and inform counseling.

Agreement about end-of-life (EOL) care among advanced cancer patients and their caregivers: Associations with care received.

10021 Background: Patients with advanced cancer and their caregivers often have different preferences regarding patients’ EOL care. Disagreement in a patient-caregiver dyad can increase stress and result in suboptimal care. Understanding factors that promote agreement, as well as the effect of agreement on care received at EOL, can inform interventions to improve communication and EOL decision-making for patients and caregivers. Methods: 205 patients (Stage III or IV cancer plus limited prognosis) and their caregivers were recruited to a randomized controlled trial of a communication intervention for patients, caregivers, and providers (Cancer Communication Study, PI: Epstein). Before intervention, patients completed the Preferences for Life-Extending Treatment questionnaire, which asked their preference regarding experimental treatment, life support, and palliative care; caregivers were asked about patients’ preferences. Binomial logistic regressions analyses modeled agreement in preferences as a function of patient and caregiver demographic characteristics and EOL care received as a function of patient-caregiver agreement. Results: The majority of patient-caregiver dyads agreed about experimental treatment (60.3%), life support (63.4%), and palliative care (70.7%). Dyads were more likely to agree about palliative care when patients were female (OR = 1.94, p = .03) and non-Hispanic white (OR = 2.10, p = .07) and when caregivers were college educated (OR = 2.04, p = .03). Of the 82 patients who died during study follow-up, 57 (69.5%) received EOL care congruent with their preferences. In 19 of the 38 (50%) cases where patient-caregiver dyads disagreed, caregivers’ preferences predicted EOL care received. Dyadic agreement about life support was associated with increased odds of patients receiving/not receiving life support congruent with their preference (OR = 3.02, p = .02). Conclusions: Facilitating agreement between patients and caregivers could improve receipt of patient-centered care. A communication intervention designed to increase dyadic agreement by helping patients and caregivers discuss challenging EOL decisions might improve EOL care delivery. Clinical trial information: NCT01485627.

Risk of sepsis in patients with amyotrophic lateral sclerosis: a population-based retrospective cohort study in Taiwan

ObjectivesAmyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease, and sepsis is a frequent cause of death in hospitalised patients. We investigated the relationship between ALS and the subsequent risk...

Associations Between Personality and End-of-Life Care Preferences Among Men With Prostate Cancer: A Clustering Approach

ContextIncreased focus on patient-centered care models has contributed to greater emphasis on improving quality of life at the end of life through personalized medicine. However, little is known about individual-level factors impacting end-of-life care preferences. ObjectivesTo examine whether the five-factor model of personality explains variation in preferences for end-of-life care in men with prostate cancer. MethodsTwo hundred twelve men with a prostate cancer diagnosis (mean age = 62 years) completed a measure of the five-factor model of personality—spanning the personality dimensions of neuroticism, agreeableness, extraversion, openness, and conscientiousness—and reported on end-of-life care preferences. Cluster analyses were used to partition the sample into groups with similar care preferences. Analyses of variance and Chi-square tests were used to evaluate differences in care preferences among the groups. ResultsCluster analyses revealed three groups of participants: “comfort-oriented patients,” “service-accepting patients,” and “service-reluctant patients.” Most (67%) were comfort oriented, preferring palliative care and opposing life support services. A subset of patients were service accepting (17%), preferring both palliative care and life support, or were service reluctant (16%), preferring neither. Service-reluctant patients endorsed significantly higher levels of neuroticism (emotional instability and negativity) than comfort-oriented patients. Comfort-oriented patients endorsed significantly higher levels of agreeableness than service-accepting patients and service-reluctant patients. ConclusionFindings suggest that personality traits are associated with specific health care preferences. Individuals high on neuroticism are likely to report reluctance toward all forms of end-of-life care and may benefit from in-depth information about the process and likely outcomes of receiving life support and palliative care services.

Do-not-resuscitate orders for critically ill patients in intensive care

End-of-life decision making frequently occurs in the intensive care unit (ICU). There is a lack of information on how a do-not-resuscitate (DNR) order affects treatments received by critically ill patients in ICUs. The objectives of this study were: (1) to compare the use of life support therapies between patients with a DNR order and those without; (2) to examine life support therapies prior to and after the issuance of a DNR order; and (3) to determine the clinical factors that influence the initiation of a DNR order in ICUs in Taiwan. A prospective, descriptive, and correlational study was conducted. A total of 202 patients comprising 133 (65.8%) who had a DNR order, and 69 (34.1%) who did not, participated in this study. In the last 48 hours of their lives, patients who had a DNR order were less likely to receive life support therapies than those who did not have a DNR order. Older age, being unmarried, the presence of an adult child as a surrogate decision maker, a perceived inability to survive ultimate discharge from the ICU, and longer hospitalization in the ICU were significant predictors of issuing a DNR order for critically ill patients. This study will draw attention to how, when, and by whom, critically ill patients' preferences about DNR are elicited and honored.

Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions: White DB, Katz MH, Luce JM, et al. Ann Intern Med 2009;150:132–8

Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions: White DB, Katz MH, Luce JM, et al. Ann Intern Med 2009;150:132–8

Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions

A public health emergency, such as an influenza pandemic, will lead to shortages of mechanical ventilators, critical care beds, and other potentially life-saving treatments. Difficult decisions about who will and will not receive these scarce resources will have to be made. Existing recommendations reflect a narrow utilitarian perspective, in which allocation decisions are based primarily on patients' chances of survival to hospital discharge. Certain patient groups, such as the elderly and those with functional impairment, are denied access to potentially life-saving treatments on the basis of additional allocation criteria. We analyze the ethical principles that could guide allocation and propose an allocation strategy that incorporates and balances multiple morally relevant considerations, including saving the most lives, maximizing the number of "life-years" saved, and prioritizing patients who have had the least chance to live through life's stages. We also argue that these principles are relevant to all patients and therefore should be applied to all patients, rather than selectively to the elderly, those with functional impairment, and those with certain chronic conditions. We discuss strategies to engage the public in setting the priorities that will guide allocation of scarce life-sustaining treatments during a public health emergency.

Síndrome de shock tóxico: experiencia en una UCIP

To review patients with toxic shock syndrome (TSS) in a pediatric intensive care unit. We performed a retrospective study of patients with TSS admitted to the intensive care unit in the previous 15 years. The patients included were those that met the clinical and microbiological criteria for TSS proposed by the Centers for Disease Control and Prevention. There were nine patients (four boys). The mean age was 7 years. The most frequent findings were fever (100 %), hypotension (100 %), erythroderma (100 %), multisystem organ failure [coagulopathy (100 %), lethargy (89 %), hypertransaminasemia (89 %), increased creatine phosphokinase levels (78 %), renal failure (66 %)] and cutaneous desquamation (100 %). Laboratory studies showed changes in the leukocyte count and C-reactive protein value in all patients. The etiology was as follows: Staphylococcus was detected in six patients (S. epidermidis in three and S. aureus in three) and Streptococcus was detected in two patients (S. pyogenes in one and S. pneumoniae in one); no microorganisms were detected in only one patient. The origin of the infection was identified in seven patients (cutaneous in six patients and tonsillar in one). All patients received life support and antibiotic treatment. Six patients received corticosteroid treatment and one received intravenous immunoglobulins. Patients with TSS secondary to Streptococcus showed the greatest severity, exhibiting renal failure and requiring greater respiratory and circulatory support. All patients recovered well from the infection, without serious long-term sequelae. CONCLUSION. TSS should be included in the differential diagnosis of patients with fever, exanthema and shock, since early diagnosis has been shown to improve outcomes. S. pneumoniae should be included among the microorganisms that cause TSS. Treatment is based on life support measures and antibiotic therapy.

Who is too sick for the ICU

In this issue a paper by Joynt and Gomersall discusses the ethical issues in deciding which patients should receive life support in the form of mechanical ventilation. This is a particularly relevant topic in South African state hospitals, where intensive care beds are extremely limited yet the demand is potentially greater than in First-World countries because of our high incidence of severe trauma and infectious disease. Hospital administrators call for written admission policies, but developing these is a daunting task as few finite clinical criteria reliably predict death.

Outcome and cost implications of cardiopulmonary resuscitation in the medical intensive care unit of a comprehensive cancer center.

Intensive care unit (ICU) resources are frequently utilized in the supportive care of hospitalized patients with cancer. Patients with cancer reportedly have poor outcomes from cardiopulmonary resuscitation (CPR). The goal of this study was to evaluate the effectiveness and patient care costs of CPR applied to patients already receiving life support in an ICU. The medical records of patients who developed cardiac arrest and underwent CPR in the ICU of a comprehensive cancer center between 1993 and 2000 were reviewed. ICU charges after the first episode of CPR were analyzed. There were 5,196 admissions to the ICU during this time; 406 (8%) of the patients underwent CPR; 67% had hematologic malignancies or had undergone hematopoietic stem cell transplantation: 256 patients (63%) died at the time of the arrest, and in 150 (37%) spontaneous circulation was restored. There were 104 patients (26%) who survived more than 24 hours but ultimately died during their hospitalization; their mean time to death was 4.3 days (95% confidence interval [CI] 2.9-5.6), and mean ICU charges were $45,877 (95% CI $24,802-$66,952). Seven patients (2%) survived to be discharged. Patients who survived after CPR and were discharged from the hospital were those who had acute ventricular dysrhythmias and were resuscitated promptly. The application of CPR to cancer patients receiving life support is costly and typically does not lead to long-term survival. Cancer patients requiring admission to an ICU should receive full supportive care short of resuscitation. Providing assurances that care will remain appropriate, aggressive, and in accordance with the patient's and family's wishes can optimize compassionate care while avoiding futile life-sustaining interventions.

The Use of Risk Predictions to Identify Candidates for Intermediate Care Units: Implications for Intensive Care Utilization and Cost

To develop a predictive equation that estimates the probability of life-supporting therapy among ICU monitor admissions and to explore its potential for reducing cost and improving ICU utilization. Prospective inception cohort analysis. Forty-two ICUs in 40 US hospitals with more than 200 beds and a consecutive sample of 17,440 ICU admissions. A multivariate equation was developed to estimate the probability of life support for ICU monitoring admissions during an entire ICU stay. Demographic, physiologic, and treatment information obtained during the first 24 h in the ICU and over the first 7 ICU days. The most important determinants of subsequent risk for life-supporting (active) treatment were diagnosis, the acute physiology score of APACHE III, age, operative status, and the patient's location and hospital length of stay before ICU admission. Among 8,040 ICU monitoring admissions, 6,180 (76.8%) had a low (< 10%) risk for receiving active treatment during the ICU stay; 95.6% received no subsequent active treatment. Review of outcomes and the type and amount of therapy received suggest that most low-risk ICU monitor admissions could be safely cared for in an intermediate care setting. Objective predictions can accurately identify groups of ICU admissions who are at a low risk for receiving life support. This capability can be used to assess ICU resource use and develop strategies for providing graded critical care services at a reduced cost.

Improving intensive care unit discharge decisions

To develop predictive equations, estimating the probability that an individual intensive care unit (ICU) patient will receive life support within the next 24 hrs. Prospective, multicenter, inception cohort study. Forty-two ICUs in 40 U.S. hospitals, including 26 that were randomly selected and 14 volunteer hospitals, primarily university or large tertiary care centers. A consecutive sample of 17,440 ICU admissions. None. A series of multivariate equations were developed to create daily estimates of probability of life support in the next 24 hrs. These equations used demographic, physiologic, and treatment information obtained at the time of ICU admission and during the first 7 ICU days. The most important determinants of next day risk for life support were the current day's therapy and Acute Physiology Score of the Acute Physiology and Chronic Health Evaluation (APACHE) III score. Other predictor variables included diagnosis, age, chronic health status, emergency surgery, previous day Acute Physiology Score, and hospital stay and location before ICU admission. The cross-validated ICU day 1, 2, and 3 predictive equations had receiver operating characteristic areas of 0.90. Survival, ICU readmission rate, and the number and type of therapies received by patients predicted at < 10% risk for active treatment suggest that discharge of patients meeting these criteria to an intermediate care unit or hospital ward could reduce ICU bed demand without compromising patient safety. Accurate, objective predictions of next day risk for life support can be developed, using readily available patient information. Supplementing physician judgment with these objective risk assessments deserves evaluation for the role of these assessments in enhancing patient safety and improving ICU resource utilization.