Geo-economic variations in structure and organization of intensive care units: the ISOREA survey
Authors' conclusion
Substantial disparities exist in ICU resources and organization across income groups, countries, and ICUs. ICU capacities appeared multidimensional, extending beyond resource limitations.
Study context
- Population
- ICUs from five continents across high-income, upper-middle-income and low/lower-middle-income countriesICUs analyzed (1,426 recruited)
- Participants
- 1,225 participants
- Exposure
- ICU resources and organization by income group, between countries, and within countries
- Outcome
- Distribution of analyzed ICUs
Methodological detailselectronic case report form, structured questionnaire of 237 items
- Electronic case report form
- Structured questionnaire of 237 items
Main finding
As reported in the abstract
- High-income countries (HICs)
- 58%
- Upper-middle-income
- 20%
- Low/lower-middle-income countries (LLMICs)
- 22%
- In referral centers
- 90%
- In large urban areas
- 80%
Observational data: associations, not effects.
Further findings
| Outcome | HICs | LLMICs |
|---|---|---|
| Marshall classification | level III 79% | level I 55% |
Variables associated with income group
- Variables significantly associated with income group
- 93%
- Showing higher levels in HICs and lower levels in LLMICs
- 88%
Domains with major disparities
- Six domains: 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
Variability of ISOREA domain scores
- Domains with higher ISOREA scores varied primarily between countries; lower-performing domains exhibited greater variability across ICUs within the same country
- Adjustment for income group reduced, but did not eliminate, country-level clustering
Original publication
Geo-economic variations in structure and organization of intensive care units: the ISOREA survey. Am J Respir Crit Care Med. Published 20 October 2026. doi:10.
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