Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future

For the Global Intensive Care Working Group of the European Society of Intensive Care Medicine

Research output: Contribution to journalReview article

52 Scopus citations

Abstract

Background: Sepsis is a major reason for intensive care unit (ICU) admission, also in resource-poor settings. ICUs in low- and middle-income countries (LMICs) face many challenges that could affect patient outcome. Aim: To describe differences between resource-poor and resource-rich settings regarding the epidemiology, pathophysiology, economics and research aspects of sepsis. We restricted this manuscript to the ICU setting even knowing that many sepsis patients in LMICs are treated outside an ICU. Findings: Although many bacterial pathogens causing sepsis in LMICs are similar to those in high-income countries, resistance patterns to antimicrobial drugs can be very different; in addition, causes of sepsis in LMICs often include tropical diseases in which direct damaging effects of pathogens and their products can sometimes be more important than the response of the host. There are substantial and persisting differences in ICU capacities around the world; not surprisingly the lowest capacities are found in LMICs, but with important heterogeneity within individual LMICs. Although many aspects of sepsis management developed in rich countries are applicable in LMICs, implementation requires strong consideration of cost implications and the important differences in resources. Conclusions: Addressing both disease-specific and setting-specific factors is important to improve performance of ICUs in LMICs. Although critical care for severe sepsis is likely cost-effective in LMIC setting, more detailed evaluation at both at a macro- and micro-economy level is necessary. Sepsis management in resource-limited settings is a largely unexplored frontier with important opportunities for research, training, and other initiatives for improvement.

Original languageEnglish (US)
Pages (from-to)612-624
Number of pages13
JournalIntensive Care Medicine
Volume43
Issue number5
DOIs
StatePublished - May 1 2017

    Fingerprint

Keywords

  • Critical care
  • Resource-limited settings
  • Sepsis management

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

For the Global Intensive Care Working Group of the European Society of Intensive Care Medicine (2017). Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future. Intensive Care Medicine, 43(5), 612-624. https://doi.org/10.1007/s00134-017-4750-z