More efforts are needed to engage with the wider healthcare community and the public about what intensive care can—and can’t—achieve, say Jamie Gross and colleagues
Changing population demographics and improved chronic disease management have led to a growing proportion of patients being admitted to intensive care units (ICUs) with co-existing chronic disease and frailty.12 This has contributed to greater demand for intensive care services, which is steadily increasing at a rate of about 4% a year.3 Limited bed capacity in ICUs results in cancelled urgent operations and in non-clinical transfers to other such units.4 Given that intensive care is an expensive resource with healthcare costs for survivors that commonly extend well beyond admission,5 this trend is unlikely to be sustainable. Crucially, for patients with chronic disease and established frailty, undergoing the burden of a prolonged stay in intensive care for an acute illness may not deliver sustainable benefit,56 with the important caveat that the definition of “benefit” is a very individual thing.
Can anything be done to tackle the mismatch between supply and demand for intensive care? Perhaps part of this increasing demand is due to unrealistic expectations of what medicine—in particular intensive care—can achieve, along with an underappreciation of the burdens of both a critical care stay and future survivorship.7 One approach might be to increase public awareness about what admission to intensive care could mean for patients and their families, to facilitate informed decision making.
The onset of critical illness can be a highly stressful time for patients and their families. Most people do not express their wishes for the management of a future hypothetical life threatening crisis, so when a patient is incapacitated by acute illness relatives are often faced with the burden of trying to determine what that …

中文翻译：

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重症监护：平衡风险和收益以促进明智的决策

杰米·格罗斯（Jamie Gross）及其同事说，需要更多的努力与更广泛的医疗保健界和公众互动，以了解重症监护病房可以实现和不能实现的目标，
不断变化的人口统计数据和改善的慢性病管理导致越来越多的患者被收治并存有慢性病和虚弱的重症监护病房（ICU）。1 2这导致了对重症监护服务的更大需求，该需求以每年约4％的速度稳定增长。3重症监护病房的床位有限会导致紧急手术取消，并导致向其他此类病房的非临床转移。4鉴于重症监护是昂贵的资源，而幸存者的医疗保健费用通常远远超出入院率，5这种趋势不太可能持续。重要的是，对于患有慢性疾病，并建立脆弱，经历了长时间留在重症监护室的负担，急性疾病可能无法提供可持续的利益，5 6与重要的告诫是，“利益”的定义是一个非常个人的事情。
可以采取任何措施来解决重症监护病房供需之间的不匹配吗？需求增长的部分原因可能是由于对药物（尤其是重症监护室）所能达到的期望不切实际，以及对重症监护病房和未来生存的负担的认识不足。7一种方法可能是提高公众对重症监护病房对患者及其家庭的意义的认识，以促进明智的决策。
重症疾病的发作对于患者及其家人可能是一个压力很大的时期。大多数人没有表达对未来假想的威胁生命的危机的处理的意愿，因此，当患者因急性疾病而丧失行为能力时，亲戚通常会面临着试图确定其后果的重担。。。。。。。。。。。。。。。。。。。。。。。。。。。。。。。