Intensive Care in India in 2018-2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study.
Jigeeshu V Divatia1, Yatin Mehta2, Deepak Govil2
1Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Summary
This study on Indian intensive care units found that larger hospitals and closed ICUs are linked to worse patient outcomes. Improvements in care processes are needed, as high rates of terminal discharges persist.
Area of Science:
- Critical Care Medicine
- Health Services Research
- Epidemiology
Background:
- The study provides an update on Indian intensive care units (ICUs) following the 2010-2011 INDICAPS study.
- It examines organizational aspects, patient case mix, and clinical practices in Indian ICUs between 2018 and 2019.
Purpose of the Study:
- To assess the current state of intensive care in India.
- To identify factors associated with outcomes and adherence to care standards in Indian ICUs.
Main Methods:
- An observational, 4-day point prevalence study was conducted across 132 ICUs.
- Data on 4,669 adult patients included demographics, interventions, 24-hour care details, and up to 30-day outcomes.
- Adherence to selected process measures and patient characteristics were analyzed.
Main Results:
- The average patient age was 56.9 years, with mean APACHE II and SOFA scores of 16.7 and 4.4, respectively.
- 23.4% ICU mortality was observed, with significant rates of infection (25.6%) and sepsis (29.3%).
- Compliance varied widely, with low adherence for delirium monitoring (11.2-47.4%) and blood product transfusion (7.7-25.3%).
Conclusions:
- Larger hospital size (≥500 beds) and closed ICU models are independently associated with increased mortality.
- High rates of terminal discharges (29.3%) and suboptimal adherence to care processes highlight areas for improvement.
- Routine capnography use was low (34.8%), indicating a need for enhanced critical care practices.
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