El ritual de la falta de camas

Seventeen years have gone by since Teres1 pointed to pat ient admission decision as one of t he great et hical di lemmas facing Departments of Intensive Care Medicine (DICMs) when such Departments have come close to their full capacity. He referred to this situat ion as “ the ritual of the last bed” – a very i l lust rat ive t erm t hat was widely adopt ed among intensivists, and which underscores the conf lict that arises when a newly admit t ed pat ient ef fect ively sat urat es t he number of available beds, making it necessary not only to assess the benef it for t hat part icular pat ient but also t he consequences for t he next possible, probable or almost certain pat ient . In effect , in such a situat ion any addit ional pat ient wil l be af fected by delays (in the best of cases) or by t ransfer to another Intensive Care Unit (ICU) or to some other less special ized and prepared hospit al dependency. These considerat ions gave rise t o t he need t o est abl ish criteria for pat ient admission to and discharge from Intensive Care. The American Societ y of Crit ical Care Medicine was the f irst to establish a series of recommendat ions2 that have not been updated since 1999.3 Since then the “ success” of DICMs has increased in parallel t o t heir est abl ished ef fect iveness and ef f iciency. In t he developed part s of t he world t he percent age of overal l