Neurological intensive care in India

Intensive care units need to be optimally utilized especially in developing countries such as India where they are rare and artificial ventilators are available for a limited number of patients. Data concerning the outcome of diverse neurological emergencies are required to enable physicians to make decisions and to advise families of patients on issues such as the institution of artificial ventilation and the use of pressor agents.

We analysed 271 patients admitted over a 24-month period to our 5-bed neurological intensive care unit, and related the outcome to the occurrence of coma (Group I, n=100), respiratory failure without coma (Group II, n=32) and no respiratory failure or coma (Group III, n=139). Patients with pre-terminal coma alone were included in Group III.

Whereas the three groups were similar with regard to age, sex and social class, mortality was entirely different (overall mortality 44%, Group I 86%, Group II 56% , Group III 12%). Only one comatose patient made a good recovery. Among patients requiring ventilatory support, the highest mortality was recorded in comatose patients (62/65; 95%) and the lowest in those with the Guillain-Barré syndrome (6/15; 40%).

We suggest that artificial ventilation be used only in those comatose patients where the underlying cause is potentially reversible such as status epilepticus and that a multicentre study be conducted in the Third World on the prognosis of coma and the use of intensive care units.