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. 2025 Dec 5;26(1):27.
doi: 10.1186/s12871-025-03473-5.

Characteristics of French intensive care units and patients: an ancillary analysis of the GAME-OVER study

Enora Atchade  1   2 , Pierre-Julien Cungi  3 , Stéphanie Pons  4   5 , Claire Dahyot-Fizelier  6 , Magali Cesana  7 , Anne Claire Lukaszewicz  8   9 , Belaid Bouhemad  10   11 , Pierre Trouiller  12 , Jonathan Chelly  7   13 , Philippe Montravers  14   15   16 , Fanny Vardon  17 , Erwan D'Aranda  7 ; SFAR Critical Care Committee; SFAR Sustainability Committee; SFAR Research Network; GAME-OVER Study group; GAME-OVER investigators group
Collaborators, Affiliations

Characteristics of French intensive care units and patients: an ancillary analysis of the GAME-OVER study

Enora Atchade et al. BMC Anesthesiol. .

Abstract

Background: Intensive care units (ICUs) account for 15 to 20% of the national healthcare expenditures in France, although representing only 2% of the annual national hospitalizations. Published data on critically ill patient characteristics and intensive care unit (ICU) organizational aspects in France are scarce but could help optimize the critical care system organization.

Methods: We performed an ancillary analysis of the GAME-OVER study, conducted from November 2022 to March 2023, over a 24-h period in each ICU, to precisely describe the ICU activity in France. Characteristics of enrolled patients and ICUs were analyzed according to the healthcare structure type and the self-reported main activity of each ICU, and were compared using univariate analysis (p < 0.05 considered as significant).

Results: Data from 81 ICUs, representing 1218 beds, were analyzed. Participating ICUs were mainly mixed ICUs (56%), from teaching hospitals (54%). Among the 1048 analyzed ICU patients, sex ratio female/male was 1/3, median age was 63 [51–71] years, median sepsis organ failure assessment score was 4 [2–7], and 42% of patients had at least two organ failures. Patients were mainly admitted for medical reasons (52%), mostly represented by respiratory failure (26%). Mechanical ventilation, non-invasive ventilation, high flow oxygen therapy, renal replacement therapy and vasoactive therapy were required in 45.5%, 6.1%, 5.3%, 12% and 30.7% of patients, respectively. Median nurse-to-patient ratio was 2.4 [2.0–2.7] on day shift. Overall, 46 structures (56.8%) declared a nurse-to-patient ratio > 2.5 either on day time or night time. Bed occupancy rate was 91% over the 24-h study period. However, 70 (5.7%) ICU beds were administratively closed and could not admit any patient.

Conclusion: In more than 20% of French ICUs, the bed occupancy rate is nearly 91%, despite 5.7% of beds being unavailable, and the nurse-to-patient ratio exceeding recommended levels.

Trial registration: The full study protocol was registered in clinicaltrials.gov (NCT05553054).

Supplementary Information: The online version contains supplementary material available at 10.1186/s12871-025-03473-5.

Keywords: Critical care; Healthcare professional shortage; Intensive care; Intensive care organization; Intensive care patients; Intensive care unit activity.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the declaration of Helsinki. Clinicaltrials.gov NCT05553054. Institutional review board Centre Hospitalier Intercommunal de Toulon – La Seyne-sur-Mer, France, IRB 12962. By French law, the Ethics Committee institutional review board waived the need to obtained written informed consent from the patients. Consent for publication: Not applicable. Competing interests: SP received a mobility research grant from L’Institut Servier, outside of the submitted work. PM has received consulting fees and honoraria for consulting activity, participation to advisory boards, and presentations from Merck, Menarini, Pfizer, Mundipharma, Viatris, outside of the submitted work. PT has received consulting fees from MACSF assurances, outside of the submitted work. The other authors declare no conflicts of interest regarding the publication of this paper.

Figures

Fig. 1
Fig. 1
Flowchart of the GAME-OVER observational prospective study (ICU: intensive care unit)
See this image and copyright information in PMC

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