A survey on critical care resources and practices in low- and middle-income countries

Marija Vukoja, Elisabeth Riviello, Srdjan Gavrilovic, Neill K J Adhikari, Rahul Kashyap, Satish Bhagwanjee, Ognjen Gajic, Oguz Kilickaya

Research output: Contribution to journalArticle

32 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)337-342.E5
JournalGlobal Heart
Volume9
Issue number3
DOIs
StatePublished - 2014

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Epidemiology
  • Community and Home Care

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    Vukoja, M., Riviello, E., Gavrilovic, S., Adhikari, N. K. J., Kashyap, R., Bhagwanjee, S., Gajic, O., & Kilickaya, O. (2014). A survey on critical care resources and practices in low- and middle-income countries. Global Heart, 9(3), 337-342.E5. https://doi.org/10.1016/j.gheart.2014.08.002