Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Dec;40(6):100950.
doi: 10.1016/j.accpm.2021.100950. Epub 2021 Sep 20.

Comparison of the clinical features in open and closed format intensive care units: A systematic review and meta-analysis

Amir Vahedian-Azimi  1 , Farshid Rahimibashar  2 , Sara Ashtari  3 , Paul C Guest  4 , Amirhossein Sahebkar  5
Affiliations
Meta-Analysis

Comparison of the clinical features in open and closed format intensive care units: A systematic review and meta-analysis

Amir Vahedian-Azimi et al. Anaesth Crit Care Pain Med. 2021 Dec.

Abstract

Importance: The difference in clinical outcomes between closed and open designs of intensive care units (ICUs) is still an open question.

Objective: We conducted a systematic review and meta-analysis to compare total mortality, hospital and ICU length of stay (LOS) and mortality as primary outcomes, and severity of illness based on physiological variables, organ failure assessment, age, duration of mechanical ventilation and ventilator-associated pneumonia frequency as secondary outcomes in closed and open ICUs.

Evidence review: Medline, PubMed, Scopus, Web of Science, Cochrane database, Iran-doc and Elm-net according to the MeSH terms were searched from 1988 to October 2019. The standardised mean difference (SMD), relative risk (RR) with 95% confidence interval (CI) were applied to display summary statistics of primary and secondary outcomes.

Findings: A total of 90 studies with 444,042 participants were analysed. ICU mortality (RR: 1.16, CI: 1.07-1.27, p < 0.001), hospital mortality (RR: 1.12, CI: 1.03-1.22, p = 0.010) and ICU LOS (SMD: 0.43, CI: 0.01-0.85, p = 0.040) were significantly higher in open ICUs. Total mortality (RR: 0.91, CI: 0.77-1.08, p = 0.28) and hospital LOS (SMD: 1.14, CI: 1.31-3.59, p = 0.36) showed no significant difference between the two types of ICU. The secondary outcome measures were also comparable between the two ICU formats (p > 0.05).

Conclusions and relevance: The results demonstrated superiority of closed versus open ICUs in hospital and ICU mortality rates and ICU LOS, with no difference in total mortality, hospital LOS or severity of illness parameters. The superiority of the closed ICU format may be a result of the intensivist-led patient care and should therefore be implemented by clinicians to decrease ICU mortality rates and LOS for critically ill patients.

Keywords: Closed ICU; Intensive care unit; Length of stay; Meta-analysis; Mortality; Open ICU.

PubMed Disclaimer

Comment in

  • Further evidence in support of closed ICUs.
    Legrand M, Aldrich M. Legrand M, et al. Anaesth Crit Care Pain Med. 2021 Dec;40(6):100978. doi: 10.1016/j.accpm.2021.100978. Epub 2021 Nov 5. Anaesth Crit Care Pain Med. 2021. PMID: 34748939 No abstract available.

LinkOut - more resources