Ten major priorities for intensive care in India

Divatia, JV; Iyer, Shivakumar

doi:10.1007/s00134-014-3618-8

Cited by 7 publications

(4 citation statements)

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“…Translation of results of studies from developed countries on the impact and cost of infections to situations in developing countries may not be appropriate for several reasons: (1) different microbiological profile of HAIs[ 5 , 6 ]; (2) perceived reluctance among physicians regarding treatment of HAIs that is probably based on the impression that these infections are associated with poor survival[ 7 , 8 ]; and (3) limited resources and affordability which argues that resource allocation for the treatment of HAI would steal opportunities away from other potentially treatable patients, waiting for an intensive care unit (ICU) bed. The affordability issue is compounded by the fact that only about 10% of the estimated 70000 ICU beds in India are available in the public sector, where treatment is provided free of cost[ 9 ]. This poses a major problem of demand-supply mismatch, not only in the public sector, but also in the private sector since the population that needs to be covered in India is over 1 billion.…”

Section: Introductionmentioning

confidence: 99%

Attributable cost of a nosocomial infection in the intensive care unit: A prospective cohort study

Chacko

Thomas

Tougeron

et al. 2017

WJCCM

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AIMTo study the impact of hospital-acquired infections (HAIs) on cost and outcome from intensive care units (ICU) in India.METHODSAdult patients (> 18 years) admitted over 1-year, to a 24-bed medical critical care unit in India, were enrolled prospectively. Treatment cost and outcome data were collected. This cost data was merged with HAI data collected prospectively by the Hospital Infection Control Committee. Only infections occurring during ICU stay were included. The impact of HAI on treatment cost and mortality was assessed.RESULTSThe mean (± SD) age of the cohort (n = 499) was 42.3 ± 16.5 years. Acute physiology and chronic health evaluation-II score was 13.9 (95%CI: 13.3-14.5); 86% were ventilated. ICU and hospital length of stay were 7.8 ± 5.5 and 13.9 ± 10 d respectively. Hospital mortality was 27.9%. During ICU stay, 76 (15.3%) patients developed an infection (ventilator-associated pneumonia 50; bloodstream infection 35; urinary tract infections 3), translating to 19.7 infections/1000 ICU days. When compared with those who did not develop an infection, an infection occurring during ICU stay was associated with significantly higher treatment cost [median (inter-quartile range, IQR) INR 92893 (USD 1523) (IQR 57168-140286) vs INR 180469 (USD 2958) (IQR 140030-237525); P < 0.001 and longer duration of ICU (6.7 ± 4.5 d vs 13.4 ± 7.0 d; P < 0.01) and hospital stay (12.4 ± 8.2 d vs 21.8 ± 13.9 d; P < 0.001)]. However ICU acquired infections did not impact hospital mortality (31.6% vs 27.2%; P = 0.49).CONCLUSIONAn infection acquired during ICU stay was associated with doubling of treatment cost and prolonged hospitalization but did not significantly increase mortality.

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Section: Introductionmentioning

confidence: 99%

Attributable cost of a nosocomial infection in the intensive care unit: A prospective cohort study

Chacko

Thomas

Tougeron

et al. 2017

WJCCM

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“…[34] Effective EoL care is considered as one of the top priorities for the Indian ICUs, and EoL care is the focused theme of the Indian Society of Critical Care and Palliative care Society of India for the year 2014. [56] However, there exists a lack of consensus among the Indian medical community in dealing with many EoL issues, and the India law is still in an evolving stage in many of these pressing issues. [7]…”

Section: Introductionmentioning

confidence: 99%

Experiences in end-of-life care in the Intensive Care Unit: A survey of resident physicians

Mohamed

Muhammed

Singh

et al. 2016

Indian Journal of Critical Care Medicine

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Background and Aims:The practice of intensive care includes withholding and withdrawal of care, when appropriate, and the goals of care change around this time to comfort and palliation. We decided to survey the attitudes, training, and skills of intensive care residents in relation to end-of-life (EoL) care. All residents at our institute who has worked for at least a month in an adult Intensive Care Unit were invited to participate.Materials and Methods:After Institutional Ethics Committee approval, a Likert-scale questionnaire, divided into five composite measures of EoL skills including training and attitude, was handed over to individual residents and completed data were anonymized. Frequency and descriptive analysis was performed for the demographic variables. Central tendency, variability, and reliability were examined for the five composite measures. Scale internal consistency was checked by Cronbach's coefficient alpha. Multivariate forward conditional regression analysis was conducted to examine the association of demographic data or EoL experience to composite measures.Results:Of the 170 eligible residents, we received 120 (70.5%) responses.Conclusions:Internal medicine residents have more experience in caring for dying patients and conducting EoL discussions. Even though majority of participants reported that they are comfortable with the concept of EoL care, this does not always reflect the actual practice in the hospital. There is a need for further training in skills around EoL care. As this is a self-assessment survey, the specific measures of attitudes and skills in EoL are poorly reflected, indicating a need for further research.

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“…( 3 ) It is essential to increase the number of ICU beds and upgrade the facilities and staffing in public hospitals. ( 4 ) Investment in intensive care, including that in equipment, organization, staffing and education, may increase the initial costs, but these efforts will prove to be cost- effective in the longer term.…”

Section: Costs Of Carementioning

confidence: 99%

Caring for the critically ill in developing countries: a perspective from India

Divatia¹

2015

Revista Brasileira De Terapia Intensiva

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Ten major priorities for intensive care in India

Cited by 7 publications

References 10 publications

Attributable cost of a nosocomial infection in the intensive care unit: A prospective cohort study

Attributable cost of a nosocomial infection in the intensive care unit: A prospective cohort study

Experiences in end-of-life care in the Intensive Care Unit: A survey of resident physicians

Caring for the critically ill in developing countries: a perspective from India

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