title: Critical care capacity in Canada: results of a national cross-sectional study.
abstract: BACKGROUND
  Intensive Care Units (ICUs) provide life-supporting treatment; however, resources are limited, so demand may exceed supply in the event of pandemics, environmental disasters, or in the context of an aging population. We hypothesized that comprehensive national data on ICU resources would permit a better understanding of regional differences in system capacity.
  
  
  METHODS
  After the 2009-2010 Influenza A (H1N1) pandemic, the Canadian Critical Care Trials Group surveyed all acute care hospitals in Canada to assess ICU capacity. Using a structured survey tool administered to physicians, respiratory therapists and nurses, we determined the number of ICU beds, ventilators, and the ability to provide specialized support for respiratory failure.
  
  
  RESULTS
  We identified 286 hospitals with 3170 ICU beds and 4982 mechanical ventilators for critically ill patients. Twenty-two hospitals had an ICU that routinely cared for children; 15 had dedicated pediatric ICUs. Per 100,000 population, there was substantial variability in provincial capacity, with a mean of 0.9 hospitals with ICUs (provincial range 0.4-2.8), 10 ICU beds capable of providing mechanical ventilation (provincial range 6-19), and 15 invasive mechanical ventilators (provincial range 10-24). There was only moderate correlation between ventilation capacity and population size (coefficient of determination (R(2)) = 0.771).
  
  
  CONCLUSIONS
  ICU resources vary widely across Canadian provinces, and during times of increased demand, may result in geographic differences in the ability to care for critically ill patients. These results highlight the need to evolve inter-jurisdictional resource sharing during periods of substantial increase in demand, and provide background data for the development of appropriate critical care capacity benchmarks.
authors.affiliation: Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto, Toronto, Canada. rob.fowler@sunnybrook.ca.|Department of Critical Care Medicine, Sunnybrook Hospital, 2075 Bayview Avenue, Room D138, Toronto, Ontario, M4N 3M5, Canada. rob.fowler@sunnybrook.ca.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fowler
authors.affiliation: Office of Situational Awareness and Operations, Centre for Emergency Preparedness & Response, Health Security Infrastructure Branch, Public Health Agency of Canada, 100 Colonnade Road, Ottawa, Ontario, K1A 0K9, Canada. Philip.Abdelmalik@phac-aspc.gc.ca.
authors.forename: Philip
authors.initials: P
authors.lastname: Abdelmalik
authors.affiliation: Adult Intensive Care, Island Health Authority, Royal Jubilee Hospital, 1952 Bay St, Victoria, BC, V8R 1J8, Canada. Gordon.Wood@viha.ca.
authors.forename: Gordon
authors.initials: G
authors.lastname: Wood
authors.affiliation: Critical Care Research, Vancouver General Hospital, JPPN, ICU, Room 2469 899 12th Avenue West, Vancouver, BC, V5Z 1M9, Canada. Denise.Foster@vch.ca.
authors.forename: Denise
authors.initials: D
authors.lastname: Foster
authors.affiliation: Division of Critical Care Medicine, 3C1.16 University of Alberta Hospital, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada. Noel.Gibney@albertahealthservices.ca.
authors.forename: Noel
authors.initials: N
authors.lastname: Gibney
authors.affiliation: Memorial University of Newfoundland, Discipline of Medicine, Memorial University of Newfoundland, St John's, NL, A1B 3V6, Canada. natalie.bandrauk@med.mun.ca.
authors.forename: Natalie
authors.initials: N
authors.lastname: Bandrauk
authors.affiliation: Department of Anesthesia and Critical Care Medicine, and Population Health and Optimal Health Practices Research Unit, Centre Hospitalier Universitaire (CHU) de Québec and Université Laval, 1401, 18e Rue, H-037, Québec, G1J 1Z4, Canada. Alexis.Turgeon@fmed.ulaval.ca.
authors.forename: Alexis F
authors.initials: AF
authors.lastname: Turgeon
authors.affiliation: Centre Hospitalier Universitaire de Sherbrooke Service de médecine interne (local 4223), 3001 12e Av. N., Sherbrooke, Québec, J1H 5N4, Canada. francoislamontagne@me.com.
authors.forename: François
authors.initials: F
authors.lastname: Lamontagne
authors.affiliation: Section of Critical Care Medicine and Section of Infectious Diseases, Departments of Medicine and Medical Microbiology, University of Manitoba, 710 Park Blvd, South Winnipeg, MB, R3P-0X1, Canada. akumar61@yahoo.com.
authors.forename: Anand
authors.initials: A
authors.lastname: Kumar
authors.affiliation: University of Manitoba, ON2051 - 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada. Ryan.Zarychanski@cancercare.mb.ca.
authors.forename: Ryan
authors.initials: R
authors.lastname: Zarychanski
authors.affiliation: Dalhousie University Medical Director, Trauma Nova Scotia, Halifax, Canada. Dr.Robert.Green@Dal.ca.|Division of Critical Care Medicine, Department of Emergency Medicine, Room 349 Bethune Bld, 1276 South Park St, Halifax, NS B3H 2Y9, Canada. Dr.Robert.Green@Dal.ca.
authors.forename: Rob
authors.initials: R
authors.lastname: Green
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building, 8440-112 ST NW, Edmonton, T6G2B7, Canada. Sean.Bagshaw@albertahealthservices.ca.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.affiliation: Department of Critical Care Medicine, Institute for Public Health, University of Calgary and Alberta Health Services, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada. tstelfox@ucalgary.ca.
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
authors.affiliation: IH Critical Care Network Medical Director, Critical Care, Kelowna General Hospital, 2268 Pandosy St, Kelowna, BC, V1Y 1T2, Canada. ryan.foster@interiorhealth.ca.
authors.forename: Ryan
authors.initials: R
authors.lastname: Foster
authors.affiliation: Critical Care Medicine, University of British Columbia. Vancouver Costal Health Research Institute, Research Scientist, Center for Health Evaluation and Outcome Sciences, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. peter.dodek@ubc.ca.
authors.forename: Peter
authors.initials: P
authors.lastname: Dodek
authors.affiliation: University of Saskatchewan College of Medicine's Department of Anesthesiology, Perioperative Medicine and Pain Management, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0W8, Canada. Susan.Shaw@saskatoonhealthregion.ca.
authors.forename: Susan
authors.initials: S
authors.lastname: Shaw
authors.affiliation: Medicine, Faculty of Medicine, University of Toronto. Head, Division of Respirology University Health Network, Mount Sinai Hospital, Women's College Hospital, University Health Network, 11-124 PMB, Toronto General Hospital, 585 University Ave, Toronto, Ontario, M5G 2N2, Canada. john.granton@uhn.ca.
authors.forename: John
authors.initials: J
authors.lastname: Granton
authors.affiliation: Department of Surgery, University of Toronto. Provincial Lead, Critical Care and Trauma, Critical Care Services Ontario, St. Michael's Hospital 30 Bond Street, Toronto, ON, M5B 1W8, Canada. Bernard.Lawless@uhn.ca.
authors.forename: Bernard
authors.initials: B
authors.lastname: Lawless
authors.affiliation: Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto, Toronto, Canada. Andrea.Hill@sunnybrook.ca.|Department of Critical Care Medicine, Sunnybrook Hospital, 2075 Bayview Avenue, Room D138, Toronto, Ontario, M4N 3M5, Canada. Andrea.Hill@sunnybrook.ca.
authors.forename: Andrea
authors.initials: A
authors.lastname: Hill
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Sunnybrook Hospital, 2075 Bayview Avenue, Room D138, Toronto, Ontario, M4N 3M5, Canada. louise.rose@utoronto.ca.
authors.forename: Louise
authors.initials: L
authors.lastname: Rose
authors.affiliation: Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto, Toronto, Canada. neill.adhikari@sunnybrook.ca.|Department of Critical Care Medicine, Sunnybrook Hospital, 2075 Bayview Avenue, Room D138, Toronto, Ontario, M4N 3M5, Canada. neill.adhikari@sunnybrook.ca.
authors.forename: Neill K
authors.initials: NK
authors.lastname: Adhikari
authors.affiliation: Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto, Toronto, Canada. damon.scales@sunnybrook.ca.|Department of Critical Care Medicine, Sunnybrook Hospital, 2075 Bayview Avenue, Room D138, Toronto, Ontario, M4N 3M5, Canada. damon.scales@sunnybrook.ca.
authors.forename: Damon C
authors.initials: DC
authors.lastname: Scales
authors.affiliation: St. Joseph's Hospital, McMaster University, Hamilton, Ontario, L8N 3Z5 , Canada. debcook@mcmaster.ca.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
authors.affiliation: Keena Research Center of the Li ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. MarshallJ@smh.ca.
authors.forename: John C
authors.initials: JC
authors.lastname: Marshall
authors.affiliation: Critical Care Western and London Hospitals. Professor, Schulich School of Medicine & Dentistry, Western University Scientist, Centre for Critical Illness Research, Lawson Health Research Institute, Room D2-528 London Health Sciences Centre - Victoria Hospital PO Box 5010 800 Commissioners Road, East London, ON, N6A 5W9, Canada. Claudio.Martin@lhsc.on.ca.
authors.forename: Claudio
authors.initials: C
authors.lastname: Martin
authors.affiliation: Director of the Pediatric Intensive Care Unit/chef de service des soins intensifs pédiatriques, CHU Sainte-Justine, 3175 Chemin de Côte Sainte Catherine, Montreal, Québec, H3T 1C5, Canada. philippe.jouvet@umontreal.ca.
authors.forename: Philippe
authors.initials: P
authors.lastname: Jouvet
mesh_terms: D002170:Canada / Q000453:epidemiology; D003422:Critical Care / Q000706:statistics & numerical data* / Q000639:trends; D003430:Cross-Sectional Studies; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data* / Q000639:trends; D006742:Hospital Bed Capacity; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology / Q000628:therapy; D008297:Male; D058873:Pandemics; D012121:Respiration, Artificial / Q000706:statistics & numerical data / Q000639:trends; D011795:Surveys and Questionnaires