The practice of intensive care in Latin America: a survey of academic intensivists

Castro, Ricardo; Nin, Nicolás; Ríos, Fernando; Alegría, Leyla; Bakker, Jan; Murias, Tiberio Feliz; Friedman, Gilberto; Jibaja, Manuel; Ospina-Tascón, Gustavo Adolfo; Hurtado, Javier; Marín, María del Carmen; Machado, Flávia Ribeiro; Cavalcanti, Alexandre Biasi; Dubin, Arnaldo; Azevedo, Luciano César Pontes; Cecconi, Maurizio; Hernández, Glenn

doi:10.1186/s13054-018-1956-6

Cited by 11 publications

(11 citation statements)

References 37 publications

(38 reference statements)

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“…Our survey had a good response rate (76%) which was higher than a previously conducted similar survey in the Latin America (53%). [18] We had participation from whole spectrum of World Bank income classification for countries ranging from HICs to LMICs which allowed studying disparities across various income categories with respect to critical care resources, sepsis management, and disaster preparedness. There are some limitations in our study.…”

Section: Discussionmentioning

confidence: 99%

“…The survey was adapted from a similar critical care resources survey designed by the Latin America Intensive Care Network, [18] and modified to suit the regional setting. Since the survey was conducted during the early phase of the COVID-19 pandemic, questions specific to COVID-19 were added in addition to disaster preparedness and surge capacity.…”

Section: Survey Designmentioning

confidence: 99%

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Critical care resources, disaster preparedness, and sepsis management: Survey results from the Asia Pacific region

Kumar

Abbenbroek

Hammond

et al. 2022

JHA

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There is paucity of data on critical care resources, disaster preparedness, and sepsis management in countries within the Asia Pacific region. An online survey was conducted from 15 April to 17 July 2020. Snowball sampling through the Asia Pacific Sepsis Alliance and network contacts was used to recruit respondents. Countries were grouped according to the World Bank Country Income 2019 classification into lower-middle income (LMIC), upper-middle income (UMIC), and high-income (HIC). Survey questions addressed to hospital characteristics, critical care resources, disaster preparedness, and sepsis management. In total, 59 hospitals from 15 countries responded (33 LMICs, 8 UMICs, 18 HICs) with most responses from the Philippines (10; 16.9%). Median [Inter-quartile range (IQR)] hospital and Intensive Care Unit (ICU) bed capacity was 798 (500–1,001) and 37 (19–59), respectively. Median (IQR) doctor-to-patient and nurse-to-patient day ratios were 1:5 (1:3–1:8) and 1:2 (1:1–1:2), respectively. Availability of 24/7 physiotherapy services, 24/7 Medical resonance Imaging (MRI), point-of-care lactate, and “reserve” antibiotics was limited. Most ICUs had a disaster management plan (88%) and access to Personal Protective Equipment (96%). The most commonly adopted sepsis guideline was the Surviving Sepsis Campaign guidelines (77%). LMIC/UMIC ICUs had lower nurse-to patient ratio and surge capacity along with limited access to 24/7 physiotherapy and MRI services, and interventions like Extra Corporeal Membrane Oxygenation, and Continuous Renal Replacement Therapy. Self-reported adoption and adherence to sepsis guidelines was higher in LMICs/UMICs than HICs. In the Asia Pacific region, critical care resources, disaster preparedness and management of sepsis vary considerably between countries across different income categories. In particular, low surge and isolation capacity in LMICs highlights the need for better health service planning and preparation.

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Section: Discussionmentioning

confidence: 99%

Section: Survey Designmentioning

confidence: 99%

Critical care resources, disaster preparedness, and sepsis management: Survey results from the Asia Pacific region

Kumar

Abbenbroek

Hammond

et al. 2022

JHA

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“…A differential adoption of hand-washing practices or other quality improvement initiatives between both types of institutions might explain our findings. What is more, in a recent survey of 735 Latin-American intensivists, the evaluation of satisfactory conditions to treat septic shock was lower in public hospitals due to insufficient technology, laboratory support, imaging resources, and drug availability [47].…”

Section: Discussionmentioning

confidence: 99%

Health inequities in the diagnosis and outcome of sepsis in Argentina: a prospective cohort study

et al. 2019

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Background Socioeconomic variables impact health outcomes but have rarely been evaluated in critical illness. Low- and middle-income countries bear the highest burden of sepsis and also have significant health inequities. In Argentina, public hospitals serve the poorest segment of the population, while private institutions serve patients with health coverage. Our objective was to analyze differences in mortality between public and private hospitals, using Sepsis-3 definitions. Methods This is a multicenter, prospective cohort study including patients with sepsis admitted to 49 Argentine ICUs lasting 3 months, beginning on July 1, 2016. Epidemiological, clinical, and socioeconomic status variables and hospital characteristics were compared between patients admitted to both types of institutions. Results Of the 809 patients included, 367 (45%) and 442 (55%) were admitted to public and private hospitals, respectively. Those in public institutions were younger (56 ± 18 vs. 64 ± 18; p < 0.01), with more comorbidities (Charlson score 2 [0–4] vs. 1 [0–3]; p < 0.01), fewer education years (7 [7–12] vs. 12 [10–16]; p < 0.01), more frequently unemployed/informally employed (30% vs. 7%; p < 0.01), had similar previous self-rated health status (70 [50–90] vs. 70 [50–90] points; p = 0.30), longer pre-admission symptoms (48 [24–96] vs. 24 [12–48] h; p < 0.01), had been previously evaluated more frequently in any healthcare venue (28 vs. 20%; p < 0.01), and had higher APACHE II, SOFA, lactate levels, and mechanical ventilation utilization. ICU admission as septic shock was more frequent in patients admitted to public hospitals (47 vs. 35%; p < 0.01), as were infections caused by multiresistant microorganisms. Sepsis management in the ICU showed no differences. Twenty-eight-day mortality was higher in public hospitals (42% vs. 24%; p < 0.01) as was hospital mortality (47% vs. 30%; p < 0.01). Admission to a public hospital was an independent predictor of mortality together with comorbidities, lactate, SOFA, and mechanical ventilation; in an alternative prediction model, it acted as a correlate of pre-hospital symptom duration and infections caused by multiresistant microorganisms. Conclusions Patients in public hospitals belonged to a socially disadvantaged group and were sicker at admission, had septic shock more frequently, and had higher mortality. Unawareness of disease severity and delays in the health system might be associated with late admission. This marked difference in outcome between patients served by public and private institutions constitutes a state of health inequity. Electronic supplementary material The online versi...

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“…The electronic survey was adapted from a similar critical care resources survey designed by the Latin America Intensive Care Network 4 , and modified to suit regional needs. Survey development was iterative and was led by a working group of critical care clinicians and researchers from the region.…”

Section: Methodsmentioning

confidence: 99%

Critical Care Resources and Disaster Preparedness Survey 2020

Finfer

Hammond

Bkt

et al. 2021

Preprint

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Aim: To investigate critical care resourcing and the clinical management of sepsis in lower-middle income, upper-middle income and high income countries across the Asia Pacific region. Background: Sepsis is a time-critical complex condition that requires evidence-based care delivered by appropriate levels of well trained, qualified and experienced staff supported by proactive organisational and quality processes, sophisticated technologies and reliable infrastructure. In 2017, the estimated sepsis incidence in the Asia Pacific region ranged from 120 to 200 per 100,000 population in Australia and New Zealand to 2500 to 3400 per 100,000 population in India. Currently, there is limited information on the organisational structures, human resources, clinical standards, laboratory support and the therapeutic options available in the Asia Pacific region to treat sepsis. Method: Prospective electronic survey. Results: Representatives of 59 hospitals from 15 countries responded. Provision of critical care and the management of sepsis varied considerably between lower-middle income, upper-middle income and high income countries. Specific differences include nurse to patient ratios and availability of allied health services. Conventional organ support modalities such as mechanical ventilation and non-invasive ventilation were commonly available. Even advanced life support like extracorporeal membrane oxygenation was available in at least 60% of surveyed ICUs. However, in contrast, essential monitoring devices including EtCO2 were not universally available. Lower-middle income countries had considerably lower provisions for isolation and surge capacity to support pandemic and disaster management, though basic personal protective equipment was widely available. A majority of ICUs used the Surviving Sepsis Campaign guidelines or the adapted version for lower-middle income countries, though only 21% of ICUs in lower-middle income countries used the adapted version. While essential antimicrobials were accessible across most ICUs, availability of reserve antibiotics was limited. Conclusion: The disparities identified in this survey inform healthcare workers and health services, policy makers and governments on the priorities for action to improve the delivery of critical care and sepsis outcomes in this region. Keywords: critical care, disaster, resources, sepsis

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The practice of intensive care in Latin America: a survey of academic intensivists

Cited by 11 publications

References 37 publications

Critical care resources, disaster preparedness, and sepsis management: Survey results from the Asia Pacific region

Critical care resources, disaster preparedness, and sepsis management: Survey results from the Asia Pacific region

Health inequities in the diagnosis and outcome of sepsis in Argentina: a prospective cohort study

Critical Care Resources and Disaster Preparedness Survey 2020

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