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

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

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Journal
BMC Anesthesiology
Published
2025-12-05
DOI
https://doi.org/10.1186/s12871-025-03473-5
Primary Topic
Sepsis Diagnosis and Treatment
Type
article
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article

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

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

Camille Foucault, Clémentine Taconet, Yann Le Guen, F. Bernard, Cyril Pernod, Vedat Eljezi, Gabriel Masson, Emanuele Turbil, Hugues de Courson, Marie Geslain, Enora Atchade, Pierre‐Julien Cungi, Yannick Masson, Cyrille Geay, Bernard Rémy, Anne Bignon, M. Cesana, Guillaume Boulay, Agathe Delbove, Laurent Zieleskiewicz, Mehdi Hafiani, Emmanuelle Jaillette, Maxime Léger, Jonathan Chelly, Agathe Kudela, Jordi Miatello, Jean Turc, Adrien Auvet, Sigismond Lasocki, M. Laffon, Vincent Legros, Jean-Claude Pauchard, Noémie Claviéras, Edith Hourcastagnou, Brice Fermier, Emmanuel Besnier, F. Ferrari, Quentin Ressaire, Céline Guichon, Hadrien Winiszewski, Pierre Couhault, Inès Lakbar, Baptiste Balança, Clément Magand, Stéphanie Pons, R Berthezene, Florence Lallemant, Léa Satre Buisson, Amélie Rollé, Mathieu Schoeffler, Sylvain Garnier, Stéphane Fournier, Arnaud Sement, Benoît Boulanger, François Dépret, Jean-François Carabalona, Sophie Debord-Peguet, Riad Chelha, Pauline Bleuze, Paër-Sélim Abback, Olivier Duranteau, Marion Griton, Mathilde Delage, Bélaïd Bouhemad, Céline Monard, Djilali Elaroussi, Johan Schmitt, Sébastien Kerever, Raphaël Cinotti, Philippe Ariès, Benjamin Soyer, Charlotte Martin, Corinne Chabre, Jullien Crozon-Clauzel, Martin Mombrun, Yoann Launey, Federico Giannoni, David Vandroux, Sébastien Ehrminger, Aurélien Mazeraud, Anthony Merlin, Marie Bruyère, Stéphanie Deryckère, Vincent Pey, Françoise Labat, Laure Bonnet, Alice Jacquens, Nicolas Mayeur, Quentin Levrat, Yvonnick Boué, Fanny Planquart, Roland Amathieu, Stéphanie Sigaut, Jérémie Guillemin, Marwan Bouras, Faustine Reynaud, Mathieu Guilbart, Fanny Vardon‐Bounes, Élodie Lang, M. Fuad Jan, Marie Boulo, Emmanuelle Hammad, Erwan d’Aranda, Amaury Lhermitte, Thomas Lancry, O. Martin, Julio Badie, Dimitri Ceausu, Chloé Allary, Pierre Albaladejo, Toufik Kamel, Gaëtan Plantefève, Bernard Allaouchiche, Pierre Trouiller, Claire Dahyot‐Fizelier, Clément Hoffmann, Hélène Beloeil, Olivier Desebbe, Jérôme Morel, Mathieu Desmard, Grégoire Le Gac, A. Solesse de Gendre, Clothilde Schilte, Pierre Bouzat, Anne Claire Lukaszewicz, Benjamin Chousterman, Alexandre Godon, Philippe Montravers, Stéphanie Malaquin, Ludovic Muret, Camille Gaydon-Serres, Emmanuelle Guigal, Fanny Berenguer, Véronique Chaillet, Marion Costecalde, Abolfazl Mohebbi-Amoli, Géraldine Selly, Antoine Villecheze, Pierre-Louis Querer, Clarisse Gierczak, Jean-François Parizano, Nicolas Montgardon, David Charriere
article en

Abstract

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

BMC AnesthesiologyVol. 26(1)
Université Claude Bernard Lyon 1 (FR), Brigham and Women's Hospital (US), Inserm (FR), Délégation Paris 7 (FR), Université Fédérale de Toulouse Midi-Pyrénées (FR), Université de Poitiers (FR), Sorbonne Université (FR), Assistance Publique – Hôpitaux de Paris (FR), Hospices Civils de Lyon (FR), Pitié-Salpêtrière Hospital (FR), Fondation Ophtalmologique Adolphe de Rothschild (FR), Hôpital Edouard Herriot (FR), Centre de Recherche sur l'Inflammation (FR), Hôpital d'Instruction des Armées Sainte-Anne (FR), Maison des Sciences sociales et des Humanités de Dijon (FR), Business France (FR), Hôpital Bichat-Claude-Bernard (FR), Centre Hospitalier Intercommunal Toulon-La Seyne-sur-Mer (FR), Physiopathologie et Epidémiologie des Maladies Respiratoires (FR), Groupe de recherche clinique en anesthésie réanimation médecine périopératoire (FR)
Institut National de la Santé et de la Recherche Médicale, Université de Toulouse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Assistance publique-Hôpitaux de Paris, Ramsay Santé, Centre hospitalier régional universitaire de Lille, Centre Hospitalier Universitaire de Clermont-Ferrand, Sorbonne Université, Centre Hospitalier Universitaire de Poitiers, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine
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