We would like to thank Professor Knapik and Professor Krzych for their comments based on data from the Silesian Registry of Intensive Care Units in Poland. The high mortality rates obtained from the Polish ICUs cited in our letter  does indeed call into question issues such as quality of care and end-of-life guidelines. The data on a large number of mechanically ventilated patients, high severity of illness scores, and satisfactory ratio of observed to predicted mortality, which have been reported by Knapik and Krzych, contribute to the discussion on both the potential risk factors and level of service, and are in line with our previous findings . As such, we agree that the high mortality rates in Polish ICUs cannot be simply interpreted as results of low quality of care.
In addition, we are aware that the Polish guidelines regarding ICU triage have been published. However, as Knapik and Krzych noted, the extent to which these are being followed is unknown. The important point we wished to make is that these guidelines are not supported by either Polish legislation or by the organization of end-of-life care in Poland.
In conclusion, the reasons for high ICU mortality in Poland need to be further investigated and should be addressed properly. We are encouraged by the activity of the Silesian regional ICU registry and look forward to publication of their results. However, we are confident that the future development of intensive care in Poland requires a national registry that could provide an impetus for change in Polish legislation and healthcare organization.