Survival improvement through well-designed intensive care unit architecture

Dong Hyun Lee

doi:10.4266/acc.001500

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Editorial Basic science and research Survival improvement through well-designed intensive care unit architecture: Acute and Critical Care 2025;40(2):349-350.
DOI: https://doi.org/10.4266/acc.001500
Published online: May 30, 2025

Dong Hyun Lee

¹Department of Intensive Care Medicine, Changwon Hanmaeum Hospital, Changwon, Korea

Corresponding author: Dong Hyun Lee Department of Intensive Care Medicine, Changwon Hanmaeum Hospital, 8 Yongdong-ro 57beon-gil, Uichang-gu, Changwon 51139, Korea Tel: +82-55-255-0411 Email: rvot@daum.net

• Received: May 21, 2025 • Accepted: May 22, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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REFERENCES

With advancements in critical care medicine (CCM), its scope has expanded beyond traditional boundaries. Furthermore, these newly incorporated areas have become integral components of CCM. For instance, nutritional support and rehabilitation in the intensive care unit (ICU), previously regarded merely as "supportive therapies" or "preferable but not essential," are now universally recognized as core elements of CCM.

In this context, Jeong et al. [1] reported valuable findings that could serve as a milestone in ICU design. Designing an ICU and arranging patients or medical equipment are typically associated with considerations such as healthcare providers' convenience, patient comfort, work efficiency, or infection control. However, predicting that admitting patients to single-patient rooms (SPRs) could lead to improved patient survival would be challenging.

Jeong et al. [1] analyzed data from 3,179 ICU patients at three distinct hospitals in South Korea and reported better survival rates among patients admitted to SPRs compared to those admitted to multi-patient rooms (MPRs). This result is remarkable—almost hard to believe—as the mortality rate of patients in SPRs was 8.5%, approximately half of the 15.4% mortality rate observed among patients in MPRs. This striking result was obtained through propensity score matching to minimize bias.

Interest in and the necessity for SPRs in ICUs have significantly increased due to the coronavirus disease 2019 (COVID-19) pandemic. SPRs offer distinct advantages, including enhanced patient privacy and reduced risk of infection spread; however, they also present certain drawbacks. The Society of Critical Care Medicine recently published several recommendations regarding ICU design, one of which advises admitting patients to SPRs [2]. The guidelines indicate that while SPRs have both advantages and disadvantages compared to MPRs, the advantages appear to outweigh the drawbacks. For example, SPRs limit patient visibility and can impose restrictions on medical staff, but they are beneficial for infection control and protecting patient privacy. Nevertheless, the level of evidence for this recommendation remains low due to a lack of well-designed studies and inconsistent results.

It is encouraging that this remarkable study has been published in our journal, although further studies are anticipated in the future. However, until now, no study of comparable scale has reported the survival benefits of SPR admission in the ICU. The significance of this study might be comparable to that of the large observational study first reporting the survival benefit of early enteral feeding in ICU patients [3]. As a member of the editorial board of Acute and Critical Care, I hope this impressive study will be recognized as a pioneering landmark, widely cited by researchers and clinicians alike.

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CONFLICT OF INTEREST

Dong Hyun Lee is an editorial board member of the journal but was not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflicts of interest relevant to this article were reported.

FUNDING

None.

ACKNOWLEDGMENTS

None.

AUTHOR CONTRIBUTIONS

All the work was done by DHL.

REFERENCES

1. Jeong D, Lee D, Yoon KW, Kim HJ, Choi SY, Park CM. Comparing single-patient and multi-patient room intensive care units: a multicenter cohort study on architectural differences and clinical significance in South Korea. Acute Crit Care 2025;40:160-70.Article
2. Hamilton DK, Gary JC, Scruth E, Anderson HL 3rd, Cadenhead CD, Oczkowski SJ, et al. Society of Critical Care Medicine 2024 guidelines on adult ICU design. Crit Care Med 2025;53:e690-700.Article PubMed
3. Artinian V, Krayem H, DiGiovine B. Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. Chest 2006;129:960-7.Article PubMed

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Survival improvement through well-designed intensive care unit architecture

Acute Crit Care. 2025;40(2):349-350. Published online May 30, 2025

DOI: https://doi.org/10.4266/acc.001500

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Survival improvement through well-designed intensive care unit architecture