PubMed · 5200760
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B G Schutt. 1970. Sorting things out.. https://pubmed.ncbi.nlm.nih.gov/5200760/
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OBJECTIVES: Intensive care units (ICUs) consume substantial hospital resources, yet "efficiency" is inconsistently defined and measured. This study systematically reviewed how economic efficiency has been conceptualised and quantified in adult ICUs and appraised the quality of evidence. METHODS: Following PRISMA 2020 and a PROSPERO-registered protocol (CRD420251107866), we searched MEDLINE, Embase, CINAHL, Cochrane Library and Web of Science (2000-August 2025), plus global grey sources. Eligible studies explicitly defined efficiency and reported an efficiency metric/model linking ICU inputs (e.g., staff, beds/capacity, time, consumables, or costs) to outputs/outcomes (e.g., throughput/discharges, length of stay/resource use, risk-adjusted mortality). Dual independent screening and extraction were performed. Study quality was appraised using MMAT, and findings were synthesised narratively (SWiM), given heterogeneity. RESULTS: 39 studies (2001-2025) from 17 countries were included, all from high-income or upper-middle-income settings. Four methodological families were identified: (1) frontier modelling (predominantly DEA; occasional SFA/RFDH), (2) benchmarking indicators (risk-adjusted mortality and LOS/resource-use ratios; "efficiency matrix" quadrant classification), (3) cost-outcome evaluations, and (4) operational/process metrics. Across families, variation in decision-making units, input/output selection, and risk adjustment limited comparability; long-term and patient-reported outcomes were absent, and equity considerations were uncommon. CONCLUSIONS: ICU efficiency research is feasible but fragmented and often methodologically limited. Standardised definitions, validated risk adjustment, uncertainty quantification, and inclusion of patient-centred and equity-relevant outcomes are needed before efficiency metrics can reliably inform value-based decision making.
This paper describes a portable PC-based system for measuring respiratory system resistance (Rrs) and dynamic lung compliance (Cdyn) in intubated and mechanically ventilated patients. A pneumotachometer placed immediately proximal to the endotracheal tube measures flow, and a pressure catheter with its tip at the distal end of the endotracheal tube measures lateral airway pressure. The software is menu driven and allows the user to select from options including patient information display and entry, data collection, data editing, and waveform display. Up to ten consecutive breaths can be analyzed per run. Rrs and Cdyn are calculated on a breath by breath basis. Results are displayed to the screen, output to the system printer, and written to a user-specified ACSII data file. The system was tested by measuring resistance and compliance in a model of the lung, and results compared with those calculated from analog signals. It was then used to make measurements in intubated post-operative patients. Results were comparable to those previously reported in intubated ICU patients without primary lung disease. We conclude that our system provides reliable measurements of lung mechanics in the intubated patient, and represents an inexpensive and more versatile alternative to microprocessor-based ventilator systems currently being marketed.
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