Intensive Care in India: The Indian Intensive Care Case Mix and Practice Patterns Study

Abstract

Aims:To obtain information on organizational aspects, case mix and practices in Indian Intensive Care Units (ICUs).Patients and Methods:An observational, 4-day point prevalence study was performed between 2010 and 2011 in 4209 patients from 124 ICUs. ICU and patient characteristics, and interventions were recorded for 24 h of the study day, and outcomes till 30 days after the study day. Data were analyzed for 4038 adult patients from 120 ICUs.Results:On the study day, mean age, Acute Physiology and Chronic Health Evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores were 54.1 ± 17.1 years, 17.4 ± 9.2 and 3.8 ± 3.6, respectively. About 46.4% patients had ≥1 organ failure. Nearly, 37% and 22.2% patients received mechanical ventilation (MV) and vasopressors or inotropes, respectively. Nearly, 12.2% patients developed an infection in the ICU. About 28.3% patients had severe sepsis or septic shock (SvSpSS) during their ICU stay. About 60.7% patients without infection received antibiotics. There were 546 deaths and 183 terminal discharges (TDs) from ICU (including left against medical advice or discharged on request), with ICU mortality 729/4038 (18.1%). In 1627 patients admitted within 24 h of the study day, the standardized mortality ratio was 0.67. The APACHE II and SOFA scores, public hospital ICUs, medical ICUs, inadequately equipped ICUs, medical admission, self-paying patient, presence of SvSpSS, acute respiratory failure or cancer, need for a fluid bolus, and MV were independent predictors of mortality.Conclusions:The high proportion of TDs and the association of public hospitals, self-paying patients, and inadequately equipped hospitals with mortality has important implications for critical care in India.

Study of Factors Affecting Deaths in Medicine Ward Patients Including MICU at a Teaching and Tertiary Care Hospital Located in Central India during Period 2013 to 2016

“…[28] Also spending power is more in higher socioeconomic class, therefore bearing the expense of costly treatments of critical care is also more in this group and least in low socioeconomic group. [25] Similar finding was encountered in our present study when we found that majority of this class gave a positive history of alcoholism or smoking or both, in some cases. Maximum deaths occurred in age group 31-50 which differs from finding of other such studies.…”

“…This finding is in corroboration with findings of other studies conducted in other parts of globe. [24,25] One of the reason in of this high ratio in our hospital might be attributed to rural population in our area. Being a rural healthcare setup major chunk of deceased patients belonged to low socioeconomic class.…”

“…Maximum deaths occurred in age group 31-50 which differs from finding of other such studies. [24,29,30,25] These studies reported maximum deaths in age group 51-70 years. This finding in our study might be attributed to sedentary lifestyle and improper nutrition, lack of awareness of harmful effects of addictions, more incidence of infections in this rural part of country.…”

Evaluation of acute physiology and chronic health evaluation (APACHE) II in predicting ICU mortality among critically ill

“…A multi center observational point prevalence study (INDICAPS) conducted in India had patients with moderate severity of illness as evidenced by APACHE II of 17.4(SD±9.2). 20 This signifies that there is a need for improvements in the organization and delivery of critical care in Indian ICUs. APACHE score is declared the "gold standard" for the evaluation of intensive care and is one of the most commonly used scoring system in intensive care unit around the world.…”

“…Overall studies from abroad and India reported to have ICU length of stay between 3-11 days. [20][21][22] Therefore the main goal of the health system should focus on cost reduction by decreasing the length of stay both in ICU and hospital by providing a system of patient centered quality care.…”