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Reading: A Survey on Critical Care Resources and Practices in Low- and Middle-Income Countries

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Original Research

A Survey on Critical Care Resources and Practices in Low- and Middle-Income Countries

Authors:

Marija Vukoja ,

Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Faculty of Medicine, University of Novi Sad, Novi Sad, RS
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Elisabeth Riviello,

Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, US
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Srdjan Gavrilovic,

Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Faculty of Medicine, University of Novi Sad, Novi Sad, RS
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Neill K.J. Adhikari,

Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, CA
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Rahul Kashyap,

Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, US
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Satish Bhagwanjee,

Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, US
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Ognjen Gajic,

Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, US
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Oguz Kilickaya,

Department of Anesthesiology and Reanimation, Gulhane Military Medical Faculty, Ankara, TR
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CERTAIN Investigators

Abstract

Background: Timely and appropriate care is the key to achieving good outcomes in acutely ill patients, but the effectiveness of critical care may be limited in resource-limited settings.

Objectives: This study sought to understand how to implement best practices in intensive care units (ICU) in low- and middle-income countries (LMIC) and to develop a point-of-care training and decision-support tool.

Methods: An internationally representative group of clinicians performed a 22-item capacity-and-needs assessment survey in a convenience sample of 13 ICU in Eastern Europe (4), Asia (4), Latin America (3), and Africa (2), between April and July 2012. Two ICU were from low-income, 2 from low-middle-income, and 9 from upper-middle-income countries. Clinician respondents were asked about bed capacity, patient characteristics, human resources, available medications and equipment, access to education, and processes of care.

Results: Thirteen clinicians from each of 13 hospitals (1 per ICU) responded. Surveyed hospitals had median of 560 (interquartile range [IQR]: 232, 1,200) beds. ICU had a median of 9 (IQR: 7, 12) beds and treated 40 (IQR: 20, 67) patients per month. Many ICU had 1 staff member with some formal critical care training (n = 9, 69%) or who completed Fundamental Critical Care Support (n = 7, 54%) or Advanced Cardiac Life Support (n = 9, 69%) courses. Only 2 ICU (15%) used any kind of checklists for acute resuscitation. Ten (77%) ICU listed lack of trained staff as the most important barrier to improving the care and outcomes of critically ill patients.

Conclusions: In a convenience sample of 13 ICU from LMIC, specialty-trained staff and standardized processes of care such as checklists are frequently lacking. ICU needs-assessment evaluations should be expanded in LMIC as a global priority, with the goal of creating and evaluating context-appropriate checklists for ICU best practices.

Highlights

  • In intensive care units from low- and middle-income countries, trained staff and processes of care such as checklists are frequently lacking even as access to intensive care unit resources is reasonable.
  • A better understanding of existing intensive care units' capacity and evaluation of interventions to bring context-appropriate best practices to the bedside of critically ill patients should be a global priority.
How to Cite: Vukoja M, Riviello E, Gavrilovic S, Adhikari NKJ, Kashyap R, Bhagwanjee S, et al.. A Survey on Critical Care Resources and Practices in Low- and Middle-Income Countries. Global Heart. 2014;9(3):337–42. DOI: http://doi.org/10.1016/j.gheart.2014.08.002
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Published on 01 Sep 2014.
Peer Reviewed

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