Critically ill patients admitted in post-anaesthesia care units: a survey of current practices in France

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Abstract
Editor—Approximately 10% of all critically ill patients in the USA and in Europe are denied intensive care unit (ICU) admission because of bed shortage.1 Such a refusal may be associated with a modification of patient care objectives and increased mortality.2 The post-anaesthesia care unit (PACU) is an alternative setting for the care of critically ill patients.3 However, caring for the critically ill in the PACU might jeopardize the overall quality of care given to patients after elective surgery. Indeed, PACUs are not designed, equipped, or staffed to serve as ICUs. Furthermore, there is no French recommendation regarding the organization of care for critically ill patients hospitalized in the PACU. To our knowledge, no data exist in France on the frequency of admissions of critically ill patients in the PACU, and on the level of care provided. We therefore conducted a cross-sectional survey to estimate the prevalence and conditions in which critically ill patients are cared for in the PACU. A questionnaire with 112 items was addressed to 175 heads of PACUs from the main hospitals registered in the ‘Fédération Hospitalière de France’ network. Questions were asked regarding hospital activities, the estimated prevalence and type of critically ill patients hospitalized in the PACU, and the perceived satisfaction of the respondents regarding the organization of the PACU. Critically ill patients were described as patients suffering, or at risk of suffering, from one or more life-threatening acute organ failures requiring the initiation of artificial life support.4 Only such patients hospitalized in the PACU for at least 4 h were taken into account.