Critical care medicine in Nepal: where are we?

Acharya, Subhash Prasad

doi:10.1093/inthealth/iht010

Cited by 32 publications

(29 citation statements)

References 9 publications

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“…There is a high burden of critical illness, and access to ICU services is difficult and not well known in Nepal compared with other countries (Acharya, ). Limited resources and accessibility to health care make it difficult to care for CIPs in developing countries (Dhillon et al, ; Westcott et al, ).…”

Section: Introductionmentioning

confidence: 99%

Lived experiences of intensive care nurses in caring for critically ill patients

Limbu

Kongsuwan

Yodchai

2018

Nursing in Critical Care

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Intensive care nurses need to enhance their knowledge and skills related to the use of technologies and patient care by attending training programs and gaining further education. This study recommends that hospital administrators should support sufficient facilities and technologies of care and, in particular, increase the competency of nurses in caring for critically ill patients as the whole person.

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Section: Introductionmentioning

confidence: 99%

Lived experiences of intensive care nurses in caring for critically ill patients

Limbu

Kongsuwan

Yodchai

2018

Nursing in Critical Care

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“…Epidemiologic studies are typically cross-sectional and, except for few studies, have limited longitudinal follow-up to assess survival outcomes [5,15]. There is also limited data on ICU capacity in resource-limited settings [3,33,42], and only a few assessments are population based [12,43,44], precluding accurate national estimates of ICU capacity or the number ICU-treated critically ill patients.…”

Section: Challenges To Critical Care In Resource-limited Settings Gapmentioning

confidence: 99%

Global Critical Care: Moving Forward in Resource-Limited Settings

Dı́az

Riviello

Papali

et al. 2019

Annals of Global Health

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IntroductionCritical care is an important component of health care systems around the world (Figure 1). Caring for critically ill patients in resource-rich settings typically involves treatment in intensive care units (ICUs) staffed with highly specialized health care professionals, systematic monitoring and use of high-cost technology [1]. Unfortunately, these components are not always available in resource-limited settings [2, 3], where the burden of disease is greater [4], outcomes are poorer [5, 6], and local characteristics require context-specific approaches to the organization of critical care services.Critical care delivery, education, and research require a global perspective based on epidemiologic considerations. The burden of critical illness in resource-limited settings is not well described, but the best available estimates suggest that it may be greater than in resource-rich settings [7, 8] due to deficiencies in access to health care, emergency triage, and lack of early recognition [9][10][11]. Mortality for adults with sepsis [5, 12, 13] and acute respiratory distress syndrome (ARDS) [14][15][16] in resource-limited settings is higher than in resource-rich settings, and decedents are usually young (mean age 35 years vs. 61 years in United States) [12,17], which contributes to a greater negative downstream social and economic impact. Similarly, there is a higher burden of sepsis and respiratory infection mortality among children [18][19][20][21]. Recent epidemiological changes in global health have created a ' double burden of disease' to resource-limited settings [9,22] due to an increase in the prevalence of non-communicable diseases combined with lack of improvement in the long-recognized higher burden of communicable diseases, maternal and child mortality, malnutrition, and human immunodeficiency virus (HIV)-related complications.Health care professionals from resource-rich and resource-limited settings should take a global perspective on critical care for both ethical and practical reasons. Ethically, health care professionals, trainees, professional societies, non-governmental organizations (NGOs), and international organizations from resource-rich settings have the capacity of deploying resources to improve outcomes for critically ill patients in resource-limited settings [11,23,24]. Assistance can include financial help, knowledge exchange in the form of research and educational partnerships, and capacity building in operations and implementation science. From a practical point of view, supporting resource-limited settings is also important given that inter-related economies, Caring for critically ill patients is challenging in resource-limited settings, where the burden of disease and mortality from potentially treatable illnesses is higher than in resource-rich areas. Barriers to delivering quality critical care in these settings include lack of epidemiologic data and context-specific evidence for medical decision-making, deficiencies in health systems organization and resources, and in...

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“…[1–6] Nonetheless, from the limited data available, case fatality rates in these ICUs remain high. [7,8] A lack of both material resources and trained staff is likely to be an important contributor.…”

Section: Introductionmentioning

confidence: 99%

“…[10] Quality training in critical care medicine is a prerequisite for good care of the ICU patient, but formal training programs are either absent or minimal in low-income and sometimes also in middle income countries. [3,5,6] The importance of training for medical and nursing staff is being increasingly emphasized by those seeking to improve ICU performance and increase capacity in these settings. [9,11]…”

Section: Introductionmentioning

confidence: 99%

Impact of a structured ICU training programme in resource-limited settings in Asia

et al. 2017

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ObjectiveTo assess the impact on ICU performance of a modular training program in three resource-limited general adult ICUs in India, Bangladesh, and Nepal.MethodA modular ICU training programme was evaluated using performance indicators from June 2009 to June 2012 using an interrupted time series design with an 8 to 15 month pre-intervention and 18 to 24 month post-intervention period. ICU physicians and nurses trained in Europe and the USA provided training for ICU doctors and nurses. The training program consisted of six modules on basic intensive care practices of 2–3 weeks each over 20 months. The performance indicators consisting of ICU mortality, time to ICU discharge, rate at which patients were discharged alive from the ICU, discontinuation of mechanical ventilation or vasoactive drugs and duration of antibiotic use were extracted. Stepwise changes and changes in trends associated with the intervention were analysed.ResultsPre-Training ICU mortality in Rourkela (India), and Patan (Nepal) Chittagong (Bangladesh), was 28%, 41% and 62%, respectively, compared to 30%, 18% and 51% post-intervention. The intervention was associated with a stepwise reduction in cumulative incidence of in-ICU mortality in Chittagong (adjusted subdistribution hazard ratio [aSHR] (95% CI): 0.62 (0.40, 0.97), p = 0.03) and Patan (aSHR 0.16 (0.06, 0.41), p<0.001), but not in Rourkela (aSHR: 1.17 (0.75, 1.82), p = 0.49). The intervention was associated with earlier discontinuation of vasoactive drugs at Rourkela (adjusted hazard ratio for weekly change [aHR] 1.08 (1.03, 1.14), earlier discontinuation of mechanical ventilation in Chittagong (aHR 2.97 (1.24, 7.14), p = 0.02), and earlier ICU discharge in Patan (aHR 1.87 (1.02, 3.43), p = 0.04).ConclusionThis structured training program was associated with a decrease in ICU mortality in two of three sites and improvement of other performance indicators. A larger cluster randomised study assessing process outcomes and longer-term indicators is warranted.

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Critical care medicine in Nepal: where are we?

Cited by 32 publications

References 9 publications

Lived experiences of intensive care nurses in caring for critically ill patients

Lived experiences of intensive care nurses in caring for critically ill patients

Global Critical Care: Moving Forward in Resource-Limited Settings

Impact of a structured ICU training programme in resource-limited settings in Asia

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