Mapping intensive care across Ibero-America: The FEPIMCTI multinational survey of bed capacity, workforce, and pandemic response.

BACKGROUND

Intensive care resources are unequally distributed across Ibero-America, and reliable comparable data are scarce, hindering cross-national comparison and health-system planning.

METHODS

We conducted a cross-sectional survey of the 25 national critical care societies affiliated with FEPIMCTI. Presidents or designated representatives reported country-level data on ICU beds, intensivist and nursing workforce, organizational models, training pathways, and surge capacity before and during the COVID-19 pandemic. Resource density was summarized as the country-level median with IQR and as the population-weighted regional rate.

RESULTS

Twenty-one countries, including Spain and Portugal, participated, representing 693.6 million inhabitants. A total of 78,723 ICU beds were reported (country-level median 6.1 per 100,000, IQR 3.3-12.4; population-weighted rate 11.3), with public ICUs accounting for 51.6%. A total of 23,803 intensivists were identified (median 2.6 per 100,000, IQR 1.0-5.0), with five countries below 1 per 100,000. Nurse-to-patient ratios ranged from 1:1 to 1:7, and universal 24/7 intensivist coverage was reported in only a subset of countries. During the pandemic, ICU bed capacity rose 69%; among the 20 countries with data for both periods, physician involvement rose 32%, largely through redeployment of non-intensivists rather than growth of the certified workforce.

CONCLUSIONS

Critical care capacity, workforce, and organization vary widely across Ibero-America, with many countries below high-income benchmarks and pandemic surges met largely through temporary redeployment. These findings provide the first coordinated regional benchmark to guide workforce development, standardized training, and organizational strengthening.