Critical care medicine in the Western Pacific region

The Western Pacific region has seen rapid recent economic development but variation in the provision and organisation of intensive care units (ICUs) between different countries remains. While Japan, Australia, New Zealand, Singapore, Taiwan, Korea and Hong Kong have well developed intensive care facilities, in other countries the more limited funding for healthcare can be reflected by differential availability of modern medical technology between the public and private sectors. Other factors important to intensive care include physician training, availability of other staff and whether intensive care is delivered in "open" or "closed" units. At present only Japan, Hong Kong, the Philippines, Australia and New Zealand have a postgraduate examination in intensive care leading to recognition as an intensive care physician. In Japan, Australia, New Zealand and Indonesia each hospital usually has a single multidisciplinary (medical-surgical) ICU, whereas most other Western Pacific countries have divided medical and surgical units. In Japan, Australia, New Zealand, Hong Kong, Taiwan and Thailand, the larger ICUs are usually staffed by full-time intensivists. Future development of intensive care in the region will parallel economic development. In most countries increasing patient expectations, ageing populations and "Western" diseases will increase demand for intensive care services. Only a few countries currently have recognised programmes of training and certification in intensive care but as more adopt this process it should lead to a clearer recognition and acceptance of the role of the intensivist.