American journal of respiratory and critical care medicine
October 20, 2026 · via Europe PMC
Geo-economic variations in structure and organization of intensive care units: the ISOREA survey.
Mekontso Dessap A, Myatra SN, Roche-Campo F, +8 more, Gendreau S
AI summary — for doctors, generated from the abstract only
ICU resources and organization differ widely across income groups and countries, with most low-income ICUs lacking advanced capabilities.
What was studied
Global cross-sectional survey of 1,225 analyzed ICUs (58% high-income, 20% upper-middle, 22% low/lower-middle income) with a 237-item questionnaire and standardized domain scores.
Key findings
- 93% of variables were significantly associated with income group, mostly higher in high-income countries
- 79% of high-income ICUs were level III versus 55% of low/lower-middle-income ICUs classified as level I
- Major gaps included extracorporeal and respiratory support, emergency interventional radiology and surgery, and monitoring
Clinical relevance
Informs resource planning and benchmarking, and shows capacity differences go beyond resource limits.
Who should care
Limitations
Voluntary survey with mostly referral and urban centers, so participating ICUs may not represent all ICUs.
Use these findings to benchmark local ICU capabilities and prioritize targeted gaps.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
PURPOSE
Little is known on critical care services globally. This study aimed to describe ICU resources and organization across countries and assess variability by income group, between countries, and within countries.
METHODS
Participating centers provided structured data on hospital and ICU characteristics via electronic case report form (January 2018 to July 2020). Questionnaire included 237 items covering general characteristics (2 topics) and ICU resources and organization (18 topics). We computed standardized functional domain scores (ISOREA score), classified ICUs using Marshall criteria, and readiness for essential emergency and critical care using a modified Schell score.
RESULTS
A total of 1,426 ICUs from five continents were recruited, and 1,225 were analyzed, from high-income countries (HICs, 58%), upper-middle-income (20%), and low/lower-middle-income countries (LLMICs, 22%). Most ICUs were in referral centers (90%) and large urban areas (80%). Most variables (93%) were significantly associated with income group, Most variables (93%) were significantly associated with income group, with 88% showing higher levels in HICs and lower levels in LLMICs. Six domains showed major disparities: extracorporeal support, respiratory support, emergency access to interventional radiology and surgery, neurology and trauma care, patient file and general monitoring, and cardiovascular and hemodynamic monitoring. According to the Marshall classification, 79% of ICUs in HICs were classified as level III, whereas 55% of ICUs in LLMICs were classified as level I. Domains with higher ISOREA scores varied primarily between countries, whereas lower-performing domains exhibited greater variability across ICUs within the same country. Adjustment for income group reduced, but did not eliminate, country-level clustering.
CONCLUSION
Substantial disparities exist in ICU resources and organization across income groups, countries, and ICUs. ICU capacities appeared multidimensional, extending beyond resource limitations.
DOI
10.1093/ajrccm/aamag484
PMID
42899389
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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