ABSTRACT
The advancement of care on the intensive care unit (ICU) has improved survival in the catastrophically ill patient. The improvement in medical technology and a greater understanding of many disease states has led to an increased demand for intensive care beds and has created an increased strain on our current healthcare system. It is projected that by 2017, healthcare spending will reach over US$4.3 trillion dollars. Forty per cent of healthcare resources are consumed by critical care medicine; critical care costs account for 1 per cent of the US gross domestic product. It is generally accepted that the cost of a critical care bed is three times the cost of a non-critical care bed.1 Critical care costs have increased by 190 per cent from 1985 to 2000.2 Chronic ventilated patients require expensive care that is inadequately reimbursed. In a study of 70 Medicare patients, a net loss of US$16 600 per venti lated patient was reported.3 Moreover, the increased demands for ICU care have led to competing demands for the use of a relatively small number of ICU beds. Efforts to decrease ICU length of stay for chronic ventilated patients are desperately needed to contain the costs associated with critical care medicine and also to free up ICU beds for other types of critically ill patients who do not require chronic ventilation.
