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Evaluation of ICU practice in Scandinavia

INTENSIVE care medicine is a relatively young discipline, which in the Scandinavian countries is within the Anaesthesia speciality. Throughout the world the organization of intensive care medicine is very variable. Intensive care units (ICUs) may serve only one medical discipline or they may, as is most common in the Scandinavian countries, be multidisciplinary. The speciality of the doctors in charge of ICUs, the intensivists, also varies. In the Scandinavian countries an anaesthesiologist, profiled towards intensive care medicine is most common, but in other countries pulmonologists, surgeons, paediatricians, gastroenterologists etc, may also become intensivists. This diversity in organization results in variability in routines, practice and perhaps also outcome. When scientific reports in intensive care medicine are evaluated, the patient population profile is of utmost importance. In addition, the routines and practices also have a considerable impact on the interpretation of the results. In short, are the published findings relevant for my patients and within my practice? To answer this question an appropriate profile of the patients studied and the ICU or ICUs involved must be at hand. In addition the individual intensivist must have complete information of his/her patients, the ICU routines and outcome. The outcome should be documented in the form of a standardized and communicable registration on the local, national and international level. In the majority of the Scandinavian countries there are national ICU registries, and in Europe work with SAPS III is ongoing. The advantage of participating in a national or international registry is of course that your own data is put into a wider perspective, and one can compare outcome with the current international standard. Furthermore, ICU characteristics are necessary for the interpretation of patient studies. The importance of this is emerging. It has been known for some time that although the APACHE II score during the first 24 h of ICU care predicts ICU mortality, the exact relationship varies between countries and also between ICUs within the same country. Regarding the patients, this relates to demographic differences such as the public health situation of the population, and in the ICUs this of course relates to organization, equipment, beds available, as well as the training skills of the doctors and nurses. There is no general accepted classification system for these ICU-related variables, but it is becoming more and more obvious that this has to be taken into consideration when discussing how to interpret published data, and also when implementing new findings into our own practice. There is relatively little published information on the patient population and routines in intensive care medicine in Scandinavia. There are small pilot studies focusing on pathological mechanisms and treatment modalities and there is ongoing participation in a number of international multicentre studies. Also there are a few epidemiological studies such as the incidence study of ARDS/ALI in Denmark, Iceland and Sweden (1). To facilitate ICU studies, where a multicentre design is necessary to recruit a sufficient number of patients, a Scandinavian Intensive Care Medicine network, SCCTG (Scandinavian Critical Care Trails Group) has been created (2). The well-known Canadian network was a good example that stimulated this initiative (3). The idea is of course to build a basis for prospective, randomized, double-blinded, controlled clinical trials whenever possible multicentre in character, within the framework of The Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI). The necessary network is now being constructed and a number of projects are ongoing. The most important project is perhaps to characterize the incidence and outcome of sepsis in Scandinavia. There is an obvious need for proper evaluation of the actual ICU practice, routines and outcome. One of the first efforts in this direction is published in the present issue of Acta Anaesthesiologica Scandinavica by Oldner et al. (4). It is a point prevalence study where routines regarding the use of vasopressor and inotropic drug therapies in Scandinavian ICUs Acta Anaesthesiol Scand 2003; 47: 1185—1186 Copyright # Acta Anaesthesiol Scand 2003 Printed in Denmark. All rights reserved ACTA ANAESTHESIOLOGICA SCANDINAVICA